Healthcare Provider Details

I. General information

NPI: 1790405033
Provider Name (Legal Business Name): TYLER FARRELL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 CARRIAGE HOUSE TER APT D
SILVER SPRING MD
20904-2285
US

IV. Provider business mailing address

1611 CARRIAGE HOUSE TER APT D
SILVER SPRING MD
20904-2285
US

V. Phone/Fax

Practice location:
  • Phone: 178-269-1310
  • Fax:
Mailing address:
  • Phone: 178-269-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number06309
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: