Provider Demographics
NPI:1285133827
Name:SAINT-LOUIS, TYBULE
Entity type:Individual
Prefix:
First Name:TYBULE
Middle Name:
Last Name:SAINT-LOUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 NEWMARK CIR SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-6711
Mailing Address - Country:US
Mailing Address - Phone:772-213-2301
Mailing Address - Fax:
Practice Address - Street 1:1937 NEWMARK CIR SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-6711
Practice Address - Country:US
Practice Address - Phone:772-213-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-51519103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst