Provider Demographics
NPI:1285242677
Name:MCCORD, TYLER LEE (LMSW)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:LEE
Last Name:MCCORD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 E LARSON LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7229
Mailing Address - Country:US
Mailing Address - Phone:734-486-5579
Mailing Address - Fax:
Practice Address - Street 1:3635 E LARSON LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-7229
Practice Address - Country:US
Practice Address - Phone:734-486-5579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010936471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical