Provider Demographics
NPI:1124149893
Name:TYLER, JINI F P (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JINI
Middle Name:F P
Last Name:TYLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 RIBBON LN
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4190
Mailing Address - Country:US
Mailing Address - Phone:770-760-1085
Mailing Address - Fax:
Practice Address - Street 1:997 COMMERCE DR SW
Practice Address - Street 2:SUITE 3A
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6647
Practice Address - Country:US
Practice Address - Phone:770-361-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0037531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical