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General NPI Number Information
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NPI Number | 1518457365
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Entity Type | Individual
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Provider Name | TYLER PENA
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Gender | Male
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 10537 S ROBERTS RD
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City | PALOS HILLS
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State | IL
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Zip | 60465-1933
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Country | US
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Telephone | 708-974-2300
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Fax | 708-974-2498
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Provider Business Mailing Address
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Address Line | 10537 S ROBERTS RD
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City | PALOS HILLS
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State | IL
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Zip | 60465-1933
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Country | US
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Telephone | 708-974-2300
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Fax | 708-974-2498
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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 | 180014127
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | IL
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