Tyler Brooks Keziah, LPC, LCAS, CSI

Primary specialty

CounselorTaxonomy code 101Y00000X

License

7792 Issued in NC

Practice address

110 W Walker Ave
Asheboro, NC 27203-6760

Phone

(336) 633-7000

Fax

(336) 625-3817

NPI assigned

Apr 27, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tyler.keziah.p1@direct.daymarkrecovery.nextgenshare.com

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.

• Daymark Recovery Services, Inc.

  • Multi-Specialty Clinic/Center
  • Concord, NC
  • NPI 1558329243

  Counselor

  Medicare reassignment NPD

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

{
    "created_epoch": "1272326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494288000000",
    "number": "1376860643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DR",
            "address_2": "SUITE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251831",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W WALKER AVE",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "272036760",
            "telephone_number": "336-633-7000",
            "fax_number": "336-625-3817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEZIAH",
        "first_name": "TYLER",
        "middle_name": "BROOKS",
        "credential": "LPC, LCAS, CSI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-27",
        "last_updated": "2017-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1889",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "7792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlyn Kendrick
• Craig Kerbo, P.T.
• Ashley Pfannenstiel Kern, DNP AGNP
• James M Kernodle Jr., OD PA
• Key to Wellness NP, PLLC
• KGR Health and Wellness Academy, LLC
• Khan DDS
• Jaber A. Khan, MD
• Isaac Scott Kidd
• Leslie Marie Kidd, MSW, LCSW-P

• Counselor in Asheboro, NC
• Providers in Asheboro, NC by specialty
• Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.