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General NPI Number Information
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NPI Number | 1366819930
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Entity Type | Individual
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Provider Name | JENNIFER TYLER M.S., CDC-1, ICCTP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2015
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Last Update Date | 08/30/2015
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Provider Practice Location Address
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Address Line | 10735 KENAI SPUR HWY # 2B
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City | KENAI
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State | AK
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Zip | 99611-7859
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Country | US
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Telephone | 907-283-9947
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Fax | 907-283-9949
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Provider Business Mailing Address
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Address Line | 1700 LAWTON DR # A
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City | KENAI
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State | AK
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Zip | 99611-8913
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Country | US
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Telephone | 907-283-9947
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Fax | 907-283-9949
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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 | 1025263
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1023805
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License Number State | AK
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