TYLER YOUNG QUATTLEBAUM LPC NPI 1366930802

NPI Information

NPI: 1366930802
Provider Name: TYLER YOUNG QUATTLEBAUM, LPC
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
19 E MOUNTAIN ST STE 1
FAYETTEVILLE, AR
ZIP 72701
Phone: (479) 381-0831
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Tyler Young Quattlebaum, LPC is a mental health counselor in Fayetteville, AR. Tyler Young Quattlebaum, LPC NPI is 1366930802. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

19 E MOUNTAIN ST STE 1
FAYETTEVILLE, AR
ZIP 72701-067
Phone: (479) 381-0831

The enumeration date for this NPI number is 4/30/2018 and was last updated on 10/10/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	P2210005	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	P2210005	OTHER	ARKANSAS	ARKANSAS BOARD OF EXAMINERS IN COUNSELING AND MARRIAGE & FAMILY THERAPY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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