Healthcare Provider Details

I. General information

NPI: 1003746116
Provider Name (Legal Business Name): TYLER BRAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WESTERRE PKWY
RICHMOND VA
23233-1478
US

IV. Provider business mailing address

3900 WESTERRE PKWY
RICHMOND VA
23233-1478
US

V. Phone/Fax

Practice location:
  • Phone: 804-685-8424
  • Fax: 855-631-1074
Mailing address:
  • Phone: 804-685-8424
  • Fax: 855-631-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020517
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: