Individual provider Active NPI

Tyler R Burns, MA, LPC, AADC, NCC

  • Professional Counselor
  • Barboursville, WV
National Provider Identifier
1063881613
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2191 Issued in WV
Practice address
6171 Childers Rd
Barboursville, WV 25504
Phone
(304) 733-5380
Fax
(304) 733-5796
NPI assigned
Sep 24, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 2191 WV Primary

Addresses

Primary practice location

6171 Childers Rd
Barboursville, WV 25504

Mailing address

6171 Childers Rd
Barboursville, WV 25504-1227
Phone (304) 733-5380

Other identifiers 1

IdentifierTypeStateIssuer
0005355002MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240117003253 WV Practitioner - Mental Health Counselor 9830541655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stultz Sleep Study Services, PLLCGroup PAC ID 0840316204, 5 clinicians

Practice addresses (Care Compare)

6171 Childers Rd
Barboursville, WV 25504-1227
Phone (304) 733-5380

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
2191WVMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Stultz Sleep Study Services CurrentSince Jan 1, 2024 Accepting new patients

Locations

6171 Childers Rd
Barboursville, WV 25504
Phone (304) 733-5380

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527033600000",
    "number": "1063881613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6171 CHILDERS RD",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255041227",
            "telephone_number": "304-733-5380",
            "fax_number": "304-733-5796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6171 CHILDERS RD",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "25504",
            "telephone_number": "304-733-5380",
            "fax_number": "304-733-5796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNS",
        "first_name": "TYLER",
        "middle_name": "R",
        "credential": "MA, LPC, AADC, NCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-24",
        "last_updated": "2018-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WV",
            "license": "2191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005355002",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Barboursville, WV

Sources for this page

Verify at the official NPI Registry.