Healthcare Provider Details

I. General information

NPI: 1740199157
Provider Name (Legal Business Name): WILLIAM TYLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20273 REED LN
BEND OR
97702-2123
US

IV. Provider business mailing address

211 WISCONSIN ST APT 202
EAU CLAIRE WI
54703-3933
US

V. Phone/Fax

Practice location:
  • Phone: 541-327-4825
  • Fax:
Mailing address:
  • Phone: 715-379-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: