Jackson, Tyla

Jackson, Tyla is an individual health care provider with primary practice located at 70 Wood St Apt 22 , Pawtucket RI 02860. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Other Service Providers / Case Manager/Care Coordinator. Other Service Providers / Case Manager/Care Coordinator is her primary health care specialty. Jackson, Tyla can be contacted via phone (161) 751-6777.

Contact Information

Primary practice address
70 Wood St Apt 22 Pawtucket RI 02860
Phone: (161) 751-6777
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X
Other Service Providers / Case Manager/Care Coordinator 171M00000X

Profile Details

NPI number 1215420435
LBN Legal business name Jackson, Tyla
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2018
Last updated Dec 11th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215420435 NPPES
Other 1346589215 APPLIED BEHAVIORAL INTERVENTIONS

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