MEDICARE: TYLER HOWARD PSYD

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	103T00000X	Psychologist	31425	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225466477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER HOWARD PSYD

Provider Business Mailing Address
First Line	:	3371 GLENDALE BLVD STE 214
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1857
Country	:	US
Telephone Number	:	323-419-1844
Fax Number	:

Provider Business Practice Location Address
First Line	:	3371 GLENDALE BLVD STE 214
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1857
Country	:	US
Telephone Number	:	323-419-1844
Fax Number	:

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

Provider Enumeration Date	:	10/25/2013
Last Update Date	:	11/05/2019

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