Individual
TYLER STICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED., LPCC
Contact information
Practice address
207 PARKER DR UNIT 2B, LA GRANGE, KY 40031-1269
(502) 418-3469
Mailing address
1206 BURNT HILL RD, GOSHEN, KY 40026-9553
(502) 418-3469
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1243
KY
101YP2500X
Professional Counselor
1243
KY
221700000X
Art Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600863657
MAGELLAN HEALTH
KY
Enumeration date
02/01/2011
Last updated
05/19/2022
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