Provider Demographics
NPI:1437993029
Name:MARX, TYLER JOHN (LPC-IT)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:JOHN
Last Name:MARX
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 S FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-1050
Mailing Address - Country:US
Mailing Address - Phone:920-382-0027
Mailing Address - Fax:
Practice Address - Street 1:207 N SPRING ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2115
Practice Address - Country:US
Practice Address - Phone:920-382-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7976-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty