MEDICARE: TYLER SHEPHERD BS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1508706201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER SHEPHERD BS

Provider Business Mailing Address
First Line	:	902 W MAIN ST
Second Line	:
City	:	WEST FRANKFORT
State	:	IL
Zip	:	62896-2210
Country	:	US
Telephone Number	:	618-326-2772
Fax Number	:	618-937-1440

Provider Business Practice Location Address
First Line	:	115 N MADISON ST
Second Line	:
City	:	PITTSFIELD
State	:	IL
Zip	:	62363-1405
Country	:	US
Telephone Number	:	447-442-1921
Fax Number	:	447-442-1992

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

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	03/31/2026

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Directions to “ TYLER SHEPHERD BS” Practice Location

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