Provider Demographics
NPI:1588080394
Name:TYLER, MARISHA (LMFT)
Entity type:Individual
Prefix:MISS
First Name:MARISHA
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 ITHACA AVE
Mailing Address - Street 2:SUITE E-12
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8212 ITHACA AVE
Practice Address - Street 2:SUITE E-12
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2632
Practice Address - Country:US
Practice Address - Phone:505-330-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist