Healthcare Provider Details

I. General information

NPI: 1285176966
Provider Name (Legal Business Name): TYLER JONES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E TOUHY AVE
DES PLAINES IL
60018-5801
US

IV. Provider business mailing address

7733 S KING DR
CHICAGO IL
60619-2928
US

V. Phone/Fax

Practice location:
  • Phone: 847-409-1798
  • Fax:
Mailing address:
  • Phone: 773-230-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.022046
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: