Individual
TYLER STACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4500 I 55 N STE 208, JACKSON, MS 39211-5931
(601) 405-7440
Mailing address
4500 I 55 N STE 208, JACKSON, MS 39211-5931
(601) 405-7440
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6721
LA
101YP2500X
Professional Counselor
Primary
2366
MS
Other
Enumeration date
02/17/2017
Last updated
03/19/2019
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