Healthcare Provider Details

I. General information

NPI: 1457477796
Provider Name (Legal Business Name): DAWN MARIE TYLER NCC, LCPC, CCBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 OGLESBY AVE STE 300
NORMAL IL
61761-4616
US

IV. Provider business mailing address

706 OGLESBY AVE STE 300
NORMAL IL
61761-4616
US

V. Phone/Fax

Practice location:
  • Phone: 309-306-1283
  • Fax:
Mailing address:
  • Phone: 309-306-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: