=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518739085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TYLER BURGER LCADC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2023
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2349 RUSSELLVILLE RD
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42101-3986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-721-2775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 WELCH DR
-----------------------------------------------------
City | MURRAY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42071-9476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-206-2629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 285270
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------