Provider Demographics
NPI:1992129332
Name:TYLER, KATHRYN ANN (MA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:TYLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 SEDEEVA STREET
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-1413
Mailing Address - Country:US
Mailing Address - Phone:727-776-4166
Mailing Address - Fax:
Practice Address - Street 1:5255 140TH AVE NORTH
Practice Address - Street 2:PINELLAS REGIONAL JUVENILE DETENTION CENTER
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3742
Practice Address - Country:US
Practice Address - Phone:727-538-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health