Provider Demographics
NPI:1518704295
Name:NIEDERMEYER, TYLER (MA)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:NIEDERMEYER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9406 ASHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-8509
Mailing Address - Country:US
Mailing Address - Phone:260-310-0629
Mailing Address - Fax:
Practice Address - Street 1:708 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3866
Practice Address - Country:US
Practice Address - Phone:765-288-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health