Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP2500X | Professional Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1255836169 |
---|---|
Provider Name | Ms. Tyler Alexius Lange |
First Address | Slidell, LA 70461-5635 |
Second Address | Mandeville, LA 70448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2018 |
Last Update Date | 06/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009352933 | (05) | LA |
009352933 | AETNA (01) | LA |
009352933 | BLUE CROSS BLUE SHIELD (01) | LA |
009352933 | CIGNA (01) | LA |
009352933 | HUMANA (01) | LA |