Healthcare Provider Details

I. General information

NPI: 1790358091
Provider Name (Legal Business Name): TYLER ORESKOVIC MS, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 PRESIDENT ST APT 2F
BROOKLYN NY
11215-1641
US

IV. Provider business mailing address

418 BROADWAY STE N
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 828-419-0451
  • Fax:
Mailing address:
  • Phone: 317-730-6138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180017258
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178017162
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: