Healthcare Provider Details

I. General information

NPI: 1285554493
Provider Name (Legal Business Name): TYLER ELIZABETH WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 W UWCHLAN AVE STE 2B
EXTON PA
19341-3050
US

IV. Provider business mailing address

558 W UWCHLAN AVE STE 2B
EXTON PA
19341-3050
US

V. Phone/Fax

Practice location:
  • Phone: 610-674-0208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002422
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: