Healthcare Provider Details

I. General information

NPI: 1659599850
Provider Name (Legal Business Name): TYLER T WHITNEY PSYD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2273 E GALA ST SUITE 120
MERIDIAN ID
83642-7289
US

IV. Provider business mailing address

2273 E GALA ST SUITE 120
MERIDIAN ID
83642-7289
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-7104
  • Fax: 208-321-4789
Mailing address:
  • Phone: 208-888-7104
  • Fax: 208-321-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSE-202327
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY202-131
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSE202-374
License Number StateID

VIII. Authorized Official

Name: TYLER T WHITNEY
Title or Position: PRESIDENT
Credential: PSYD
Phone: 208-888-7104