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General NPI Number Information
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NPI Number | 1841507027
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Entity Type | Individual
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Provider Name | MYRA IVETTE TYLER MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 6601 STEPHENS RANCH RD
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City | LA VERNE
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State | CA
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Zip | 91750-1146
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Country | US
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Telephone | 909-392-2038
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Fax |
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Provider Business Mailing Address
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Address Line | 2218 WHITE ST
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City | PASADENA
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State | CA
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Zip | 91107-3260
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Country | US
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Telephone | 626-590-0069
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW76160
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License Number State | CA
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