Healthcare Provider Details

I. General information

NPI: 1073896437
Provider Name (Legal Business Name): CERYS L TYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 N PENIEL AVE
BETHANY OK
73008-3443
US

IV. Provider business mailing address

1404 N MCMILLAN AVE
OKLAHOMA CITY OK
73127-3049
US

V. Phone/Fax

Practice location:
  • Phone: 405-470-9556
  • Fax:
Mailing address:
  • Phone: 405-618-0286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number12219
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: