Active NPI
Jeffrey Lynn Tyler, LCSW
- Clinical Social Worker
- Breaux Bridge, LA
National Provider Identifier
1174902001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 3966
- Practice address
- 1069 Melancon Dr
Breaux Bridge, LA 70517-7125 - Phone
- (337) 205-8774
- NPI assigned
- May 26, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 3966 | LA | Primary |
Addresses
Primary practice location
1069 Melancon Dr
Breaux Bridge, LA 70517-7125
Mailing address
1069 Melancon Dr
Breaux Bridge, LA 70517-7125
Phone (337) 205-8774
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5X550 | Other | LA | MEDICARE PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432598400000",
"number": "1174902001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1069 MELANCON DR",
"city": "BREAUX BRIDGE",
"state": "LA",
"postal_code": "705177125",
"telephone_number": "337-205-8774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1069 MELANCON DR",
"city": "BREAUX BRIDGE",
"state": "LA",
"postal_code": "705177125",
"telephone_number": "337-205-8774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYLER",
"first_name": "JEFFREY",
"middle_name": "LYNN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-05-26",
"last_updated": "2015-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "LA",
"license": "3966",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER NUMBER",
"identifier": "5X550",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Breaux Bridge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.