Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003204868 |
---|---|
Provider Name | Mrs. Carmen Tyler |
First Address | Verona, PA 15147-1502 |
Second Address | Verona, PA 15147-1502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2015 |
Last Update Date | 02/01/2015 |