Provider Demographics
NPI:1477438232
Name:MANETH, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MANETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5716
Mailing Address - Country:US
Mailing Address - Phone:602-717-4678
Mailing Address - Fax:
Practice Address - Street 1:10211 N 32ND ST STE E1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3845
Practice Address - Country:US
Practice Address - Phone:602-698-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health