Provider Demographics
NPI:1588056295
Name:TYLER, JONATHAN ERIC (MA LPC SAC-IT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ERIC
Last Name:TYLER
Suffix:
Gender:M
Credentials:MA LPC SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1862
Mailing Address - Country:US
Mailing Address - Phone:920-287-0406
Mailing Address - Fax:
Practice Address - Street 1:3424 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1862
Practice Address - Country:US
Practice Address - Phone:920-287-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional