Provider Demographics
NPI:1568208551
Name:BECKER, TYLER JOSEPH
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOSEPH
Last Name:BECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CAPULET DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-4538
Mailing Address - Country:US
Mailing Address - Phone:904-602-9745
Mailing Address - Fax:
Practice Address - Street 1:124 CAPULET DR STE 102
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-4538
Practice Address - Country:US
Practice Address - Phone:904-602-9745
Practice Address - Fax:904-429-4416
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician