Provider Demographics
NPI:1558246322
Name:MUDD, TYLER (LCMHC-A, CRC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MUDD
Suffix:
Gender:M
Credentials:LCMHC-A, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHRIST SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8320
Mailing Address - Country:US
Mailing Address - Phone:859-494-7166
Mailing Address - Fax:
Practice Address - Street 1:110 CHRIST SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8320
Practice Address - Country:US
Practice Address - Phone:859-494-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19002101YM0800X
369300225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor