Healthcare Provider Details

I. General information

NPI: 1851008148
Provider Name (Legal Business Name): TYLER CHASE BRADSTREET PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8214 W 99TH ST
OVERLAND PARK KS
66212-3446
US

IV. Provider business mailing address

8214 W 99TH ST
OVERLAND PARK KS
66212-3446
US

V. Phone/Fax

Practice location:
  • Phone: 903-631-9319
  • Fax:
Mailing address:
  • Phone: 903-631-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number03556
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: