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General NPI Number Information
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NPI Number | 1659599850
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Entity Type | Organization
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Legal Business Name | TYLER T WHITNEY PSYD PC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2273 E GALA ST SUITE 120
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City | MERIDIAN
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State | ID
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Zip | 83642-7289
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Country | US
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Telephone | 208-888-7104
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Fax | 208-321-4789
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Provider Business Mailing Address
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Address Line | 2273 E GALA ST SUITE 120
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City | MERIDIAN
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State | ID
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Zip | 83642-7289
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Country | US
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Telephone | 208-888-7104
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Fax | 208-321-4789
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Authorized Official
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Title or Position | PRESIDENT
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Name | TYLER T WHITNEY
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Credential | PSYD
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Telephone | 208-888-7104
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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 | SE-202327
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY202-131
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SE202-374
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License Number State | ID
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