Individual
TYLER JACK KILBANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1031 NATIONAL RD, WHEELING, WV 26003-5709
(740) 293-4050
Mailing address
125 EDGWOOD STREET, APT 1, WHEELING, WV 26003
(304) 238-4074
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2497
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2497
LICENSE
WV
Enumeration date
02/09/2018
Last updated
03/16/2021
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