Healthcare Provider Details

I. General information

NPI: 1538095658
Provider Name (Legal Business Name): TYLA LANAI HINDS CASAC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 ASTOR AVE
BRONX NY
10467-9304
US

IV. Provider business mailing address

789 YONKERS AVE APT 1
YONKERS NY
10704-2066
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-9007
  • Fax:
Mailing address:
  • Phone: 914-309-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number41501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: