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General NPI Number Information
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NPI Number | 1023994217
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Entity Type | Individual
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Provider Name | TIANA KOYUKI GAYLORD
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Gender | Female
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 305 NE LOOP 820 STE 408
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City | HURST
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State | TX
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Zip | 76053-7214
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Country | US
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Telephone | 817-562-6089
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 AIRPORT FWY
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City | BEDFORD
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State | TX
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Zip | 76022-6775
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Country | US
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Telephone | 972-838-5218
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Fax | 972-838-5218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 110628
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License Number State | TX
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