Healthcare Provider Details

I. General information

NPI: 1215769864
Provider Name (Legal Business Name): TYLER JAMES CARLIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 29TH ST S STE 1
GREAT FALLS MT
59405-5316
US

IV. Provider business mailing address

2324 7TH AVE S
GREAT FALLS MT
59405-2923
US

V. Phone/Fax

Practice location:
  • Phone: 406-202-3289
  • Fax:
Mailing address:
  • Phone: 318-419-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-72440
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: