MEDICARE: DR. LENNON TYLER 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	PSY-2196	HI

General Provider Information

NPI Number	:	1477039345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LENNON TYLER PSYD

Provider Business Mailing Address
First Line	:	7609 ADVANTAGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6736
Country	:	US
Telephone Number	:	808-265-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	7609 ADVANTAGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6736
Country	:	US
Telephone Number	:	808-265-8303
Fax Number	:

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

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	09/28/2024

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