Provider Demographics
NPI:1053782136
Name:SUSSEX, TYLER
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:SUSSEX
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TYLER
Other - Middle Name:SUSSEX
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5855 SILVER CREEK VALLEY PLACE
Mailing Address - Street 2:NEIGHBORHOOD 3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138
Mailing Address - Country:US
Mailing Address - Phone:408-574-9140
Mailing Address - Fax:
Practice Address - Street 1:5855 SILVER CREEK VALLEY PLACE
Practice Address - Street 2:NEIGHBORHOOD 3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138
Practice Address - Country:US
Practice Address - Phone:408-574-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA826771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical