Provider Demographics
NPI:1972031979
Name:TROTTER, TYLER WADE
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:WADE
Last Name:TROTTER
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 1:3709 VANILLA NUT PL UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2274
Mailing Address - Country:US
Mailing Address - Phone:940-642-9981
Mailing Address - Fax:
Practice Address - Street 1:323 N MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3130
Practice Address - Country:US
Practice Address - Phone:702-385-3330
Practice Address - Fax:702-207-7119
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0086001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical