Healthcare Provider Details

I. General information

NPI: 1255103222
Provider Name (Legal Business Name): TYLER CAUGHIE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 ELYSIAN FIELDS AVE
NEW ORLEANS LA
70117-8208
US

IV. Provider business mailing address

1230 12TH ST
OAKLAND CA
94607-2202
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-2601
  • Fax: 888-736-9806
Mailing address:
  • Phone: 206-714-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132701
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111089-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18155
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18155
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: