MEDICARE: TYLER BROOKE KINDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	101YM0800X	Mental Health Counselor	98393	TX

General Provider Information

NPI Number	:	1144039181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER BROOKE KINDER

Provider Business Mailing Address
First Line	:	431 REGATTA LN
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-2948
Country	:	US
Telephone Number	:	817-941-0166
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 W RUSSELL ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5360
Country	:	US
Telephone Number	:	817-694-5073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	07/02/2025

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Directions to “ TYLER BROOKE KINDER ” Practice Location

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