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General NPI Number Information
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NPI Number | 1033870308
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Entity Type | Individual
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Provider Name | TYLER KACKLEY LPCMH
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Gender | Male
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 735 MAPLETON AVE STE 200
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1560
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Country | US
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Telephone | 302-224-1400
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Fax | 302-224-1402
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Provider Business Mailing Address
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Address Line | 910 S CHAPEL ST STE 102
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City | NEWARK
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State | DE
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Zip | 19713-3468
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Country | US
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Telephone | 302-224-1400
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Fax |
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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 | PC-0011149
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License Number State | DE
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