| Doctor Name: | RUSSELL M TYLER |
| NPI Number: | 1134287766 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD, LP |
| License Number: | LP0053 |
| Business Practice Address: | 115 1st St. N Brainerd, MN - 56401 |
| Business Phone Number: | 2188286274 |
| Business Fax Number: | 2188284209 |
| Mailing Address: | 723 S 5th St, BRAINERD |
| State: | MN |
| Postal Code: | 564014018 |
| Phone Number: | 2188282948 |
| Fax Number: | 2188284209 |
| NPI Enumeration Date: | 12/05/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | LP0053 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |