Healthcare Provider Details

I. General information

NPI: 1518704295
Provider Name (Legal Business Name): TYLER NIEDERMEYER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W WHITE RIVER BLVD
MUNCIE IN
47303-3866
US

IV. Provider business mailing address

9406 ASHWOOD LN
FISHERS IN
46038-8509
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-1110
  • Fax:
Mailing address:
  • Phone: 260-310-0629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: