Provider Demographics
NPI:1285778720
Name:TYLER, JULIE BENELL
Entity type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:BENELL
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 HUCKLEBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-6035
Mailing Address - Country:US
Mailing Address - Phone:214-374-1206
Mailing Address - Fax:214-374-0731
Practice Address - Street 1:4054 HUCKLEBERRY CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-6035
Practice Address - Country:US
Practice Address - Phone:214-374-1206
Practice Address - Fax:214-374-0731
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119785171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor