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General NPI Number Information
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NPI Number | 1477438232
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Entity Type | Individual
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Provider Name | TYLER MANETH
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Gender | Male
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Dates
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Enumeration Date | 08/09/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 3839 N 3RD ST STE 101
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City | PHOENIX
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State | AZ
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Zip | 85012-2068
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Country | US
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Telephone | 602-285-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 614 S 119TH AVE
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City | AVONDALE
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State | AZ
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Zip | 85323-5716
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Country | US
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Telephone | 602-717-4678
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 24054
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License Number State | AZ
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