Jennifer Tyler, M.S., CDC-1, ICCTP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1025263 Issued in AK

Practice address

10735 Kenai Spur Hwy # 2B
Kenai, AK 99611-7859

Phone

(907) 283-9947

Fax

(907) 283-9949

NPI assigned

Aug 30, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1440892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440892800000",
    "number": "1366819930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 LAWTON DR # A",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996118913",
            "telephone_number": "907-283-9947",
            "fax_number": "907-283-9949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10735 KENAI SPUR HWY # 2B",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996117859",
            "telephone_number": "907-283-9947",
            "fax_number": "907-283-9949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYLER",
        "first_name": "JENNIFER",
        "credential": "M.S., CDC-1, ICCTP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-30",
        "last_updated": "2015-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AK",
            "license": "1025263",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AK",
            "license": "1023805",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF AK",
            "identifier": "1025263",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF AK",
            "identifier": "1023805",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Kenai, AK
• Providers in Kenai, AK by specialty
• Mental Health Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.

Verify at the official NPI Registry.