=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295686608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TYLER JORDAN COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2026
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 BROAD ST
-----------------------------------------------------
City | CRANSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-3342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-680-0713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 NARRAGANSETT PARK DR STE 100
-----------------------------------------------------
City | PAWTUCKET
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02861-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-680-0713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TYLER NOTARIANNI
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 401-680-0713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------