Provider Demographics
NPI:1033097324
Name:ANGLIM, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:ANGLIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N A ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3516
Mailing Address - Country:US
Mailing Address - Phone:805-742-3300
Mailing Address - Fax:
Practice Address - Street 1:234 S N ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6606
Practice Address - Country:US
Practice Address - Phone:805-742-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool