Provider Demographics
NPI:1902152937
Name:TYLER, CLAIRE C (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:C
Last Name:TYLER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 RIDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2018
Mailing Address - Country:US
Mailing Address - Phone:601-957-3211
Mailing Address - Fax:601-957-9753
Practice Address - Street 1:1059 RIDGEWOOD PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2018
Practice Address - Country:US
Practice Address - Phone:601-957-3211
Practice Address - Fax:601-957-9753
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC67801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical