Healthcare Provider Details

I. General information

NPI: 1548996747
Provider Name (Legal Business Name): TYLER ANTHONY VANEVERY LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 W CHICAGO RD
COLDWATER MI
49036-8405
US

IV. Provider business mailing address

24 ALLANDALE DR
COLDWATER MI
49036-1010
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-8866
  • Fax:
Mailing address:
  • Phone: 517-227-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023669
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: