Provider Demographics
NPI:1427766682
Name:MADDOX, TYLER (RBT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MADDOX
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PARAGON PL STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1652
Mailing Address - Country:US
Mailing Address - Phone:804-562-6604
Mailing Address - Fax:
Practice Address - Street 1:9 PINNACLE DR STE 105
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2367
Practice Address - Country:US
Practice Address - Phone:804-562-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-22-218016106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician