Healthcare Provider Details

I. General information

NPI: 1801026778
Provider Name (Legal Business Name): TYLER ELDON MCKAY MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NE OAK VIEW DR STE A
VANCOUVER WA
98662-6157
US

IV. Provider business mailing address

9300 NE OAK VIEW DR STE A
VANCOUVER WA
98662-6157
US

V. Phone/Fax

Practice location:
  • Phone: 360-784-3305
  • Fax:
Mailing address:
  • Phone: 360-784-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL6877
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: