Provider Demographics
NPI:1396548178
Name:ENRIGHT, TYLAR ANN (TCADC)
Entity type:Individual
Prefix:
First Name:TYLAR
Middle Name:ANN
Last Name:ENRIGHT
Suffix:
Gender:F
Credentials:TCADC
Other - Prefix:
Other - First Name:TYLAR
Other - Middle Name:ANN
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102-104 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060
Mailing Address - Country:US
Mailing Address - Phone:641-872-1750
Mailing Address - Fax:
Practice Address - Street 1:102-104 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060
Practice Address - Country:US
Practice Address - Phone:641-872-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT25034101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)