Provider Demographics
NPI:1730566563
Name:MELINDA M. TYLER, LMFT, LLC
Entity type:Organization
Organization Name:MELINDA M. TYLER, LMFT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:MART
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-639-4953
Mailing Address - Street 1:18 ONECO ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-3440
Mailing Address - Country:US
Mailing Address - Phone:860-639-4953
Mailing Address - Fax:
Practice Address - Street 1:18 ONECO ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-3440
Practice Address - Country:US
Practice Address - Phone:860-639-4953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty