MEDICARE: TYLER JAMES ELIAS LMFT

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	106H00000X	Marriage & Family Therapist	132823	CA

General Provider Information

NPI Number	:	1831828920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JAMES ELIAS LMFT

Provider Business Mailing Address
First Line	:	PO BOX 1635
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93062-1635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30125 AGOURA RD STE 2B
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4345
Country	:	US
Telephone Number	:	805-400-3494
Fax Number	:

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

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	06/06/2022

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