Healthcare Provider Details

I. General information

NPI: 1356252936
Provider Name (Legal Business Name): TYLER LOSCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104A S MAIN ST
LEXINGTON NC
27292-3134
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 336-242-2450
  • Fax: 336-249-9920
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA23249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: