MEDICARE: EVAN TYLER

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	101YM0800X	Mental Health Counselor	0704015637	VA

General Provider Information

NPI Number	:	1184588972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN TYLER

Provider Business Mailing Address
First Line	:	2121 LANGHORNE RD APT 1204
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-1416
Country	:	US
Telephone Number	:	434-384-1594
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 LIGHT BLVD
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-5094
Country	:	US
Telephone Number	:	434-384-1594
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ EVAN TYLER ” Practice Location

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