Provider Demographics
NPI:1063881613
Name:BURNS, TYLER R (MA, LPC, AADC, NCC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:R
Last Name:BURNS
Suffix:
Gender:M
Credentials:MA, LPC, AADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 CHILDERS RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1227
Mailing Address - Country:US
Mailing Address - Phone:304-733-5380
Mailing Address - Fax:304-733-5796
Practice Address - Street 1:6171 CHILDERS RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-733-5380
Practice Address - Fax:304-733-5796
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005355002Medicaid
WV0005355002Medicaid