Provider Demographics
NPI:1144511148
Name:HANNUM, TYLER DEAN
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:DEAN
Last Name:HANNUM
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 1:3226 KENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8520
Mailing Address - Country:US
Mailing Address - Phone:541-543-5221
Mailing Address - Fax:
Practice Address - Street 1:3226 KENTWOOD DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8520
Practice Address - Country:US
Practice Address - Phone:541-543-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor