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Individual
MR. TYLER SHANE DOUGLAS
Active
Individual
MR. TYLER SHANE DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP61119971
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP61119971
WA
Other
Enumeration date
08/01/2018
Last updated
03/16/2026
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