Provider Demographics
NPI:1013335256
Name:CASE, TYLER (MA, CADC II)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CASE
Suffix:
Gender:M
Credentials:MA, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 STATE ST STE 270
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3647
Mailing Address - Country:US
Mailing Address - Phone:503-583-2410
Mailing Address - Fax:503-689-8097
Practice Address - Street 1:494 STATE ST STE 270
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3647
Practice Address - Country:US
Practice Address - Phone:503-583-2410
Practice Address - Fax:503-689-8097
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
ORC5028101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)