Healthcare Provider Details

I. General information

NPI: 1467090910
Provider Name (Legal Business Name): LEVI TYLER DOYLE-BARKER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 CENTENNIAL BLVD STE 2
SPRINGFIELD OR
97477-3320
US

IV. Provider business mailing address

1705 CENTENNIAL BLVD STE 2
SPRINGFIELD OR
97477-3320
US

V. Phone/Fax

Practice location:
  • Phone: 970-962-4819
  • Fax:
Mailing address:
  • Phone: 970-962-4819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: