Provider Demographics
NPI:1366713398
Name:WEBSTER, TYLER ANNE (PSYD, JD, MDR)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ANNE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:PSYD, JD, MDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 UNIVERSITY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4262
Mailing Address - Country:US
Mailing Address - Phone:650-400-7600
Mailing Address - Fax:
Practice Address - Street 1:1220 UNIVERSITY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4262
Practice Address - Country:US
Practice Address - Phone:650-400-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245393503OtherEIN