Provider Demographics
NPI:1376433359
Name:MOONEY, TYLER SCOTT (LSW)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:SCOTT
Last Name:MOONEY
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-3210
Mailing Address - Country:US
Mailing Address - Phone:815-252-2468
Mailing Address - Fax:
Practice Address - Street 1:1430 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-3210
Practice Address - Country:US
Practice Address - Phone:815-252-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1139141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical