Provider Demographics
NPI:1023994217
Name:GAYLORD, TIANA KOYUKI
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:KOYUKI
Last Name:GAYLORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 AIRPORT FWY
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6775
Mailing Address - Country:US
Mailing Address - Phone:972-838-5218
Mailing Address - Fax:972-838-5218
Practice Address - Street 1:305 NE LOOP 820 STE 408
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-7214
Practice Address - Country:US
Practice Address - Phone:817-562-6089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health