Provider Demographics
NPI:1104129766
Name:TYLER, LAUREN KIMBALL (LPCC)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:KIMBALL
Last Name:TYLER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GLITTER GULCH WAY
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-8738
Mailing Address - Country:US
Mailing Address - Phone:970-739-4626
Mailing Address - Fax:
Practice Address - Street 1:7 GLITTER GULCH WAY
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-8738
Practice Address - Country:US
Practice Address - Phone:970-739-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0156401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty