Healthcare Provider Details

I. General information

NPI: 1174241467
Provider Name (Legal Business Name): TYLER BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WASHINGTON BLVD
ARLINGTON VA
22204-5703
US

IV. Provider business mailing address

568 MOUNTAIN VISTA RD
SCOTTSVILLE VA
24590-3818
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-1550
  • Fax:
Mailing address:
  • Phone: 434-987-3358
  • 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: