Healthcare Provider Details

I. General information

NPI: 1841799251
Provider Name (Legal Business Name): TYLER HUDSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 N HIGH ST STE 250
WORTHINGTON OH
43085-2330
US

IV. Provider business mailing address

548 CATTAIL RUN
WESTERVILLE OH
43081-5634
US

V. Phone/Fax

Practice location:
  • Phone: 614-312-7128
  • Fax:
Mailing address:
  • Phone: 614-312-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1801025
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1801025
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1801025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: