Healthcare Provider Details

I. General information

NPI: 1306297353
Provider Name (Legal Business Name): TYLER DYKES BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2890 CARPENTER RD STE 1100
ANN ARBOR MI
48108-1190
US

IV. Provider business mailing address

2805 S INDUSTRIAL HWY STE 100
ANN ARBOR MI
48104-6791
US

V. Phone/Fax

Practice location:
  • Phone: 734-715-9062
  • Fax:
Mailing address:
  • Phone: 734-203-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: