Provider Demographics
NPI:1730703752
Name:MCGOWEN, TYLER LEE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:LEE
Last Name:MCGOWEN
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 JONQUIL DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4631
Mailing Address - Country:US
Mailing Address - Phone:502-468-9088
Mailing Address - Fax:
Practice Address - Street 1:635 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1056
Practice Address - Country:US
Practice Address - Phone:270-287-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263819103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst