MEDICARE: TYLER D STAPLES 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	03275T	KS

General Provider Information

NPI Number	:	1265770879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER D STAPLES PSYD

Provider Business Mailing Address
First Line	:	8456 MAURER RD
Second Line	:	APT. 837
City	:	LENEXA
State	:	KS
Zip	:	66219-2736
Country	:	US
Telephone Number	:	913-269-9621
Fax Number	:

Provider Business Practice Location Address
First Line	:	25055 W VALLEY PKWY STE 220
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-8450
Country	:	US
Telephone Number	:	913-378-1061
Fax Number	:

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

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	10/29/2024

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