Individual
JEFFREY LYNN TYLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1069 MELANCON DR, BREAUX BRIDGE, LA 70517-7125
(337) 205-8774
Mailing address
1069 MELANCON DR, BREAUX BRIDGE, LA 70517-7125
(337) 205-8774
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3966
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5X550
MEDICARE PROVIDER NUMBER
LA
Enumeration date
05/26/2015
Last updated
05/26/2015
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