Healthcare Provider Details

I. General information

NPI: 1811828304
Provider Name (Legal Business Name): TYLER JAMES DEJONG T-LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 10TH ST SE STE 201
LE MARS IA
51031-2557
US

IV. Provider business mailing address

1034 4TH AVE SE
LE MARS IA
51031-2669
US

V. Phone/Fax

Practice location:
  • Phone: 712-546-9395
  • Fax: 712-546-9395
Mailing address:
  • Phone: 712-546-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number138904
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: