Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tyler Matthew Peckham

Individual provider Mental Health Counselor · NPI 1013423367

Tyler Matthew Peckham is a Mental Health Counselor in Beavercreek, Ohio. Qualified in 2022, 4 years ago. Practices with Kettering Independent Medical Group Inc, a 700-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
4
Licensed in
OH
In the registry since
2017
Specialties on file
2
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Practice location Address checks out

3359 Kemp Rd Ste 200
Beavercreek, OH 45431-2567
Phone: (937) 490-2090
Fax: (937) 490-2780
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 303 W Ross St, Troy, OH 45373-3931 — (937) 216-9282

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence E.2505064 (OH)
Case Manager/Care Coordinator Taxonomy 171M00000X

Record details

NPI number1013423367
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 22, 2017
Last updated in NPPESOctober 3, 2025
Certification dateOctober 3, 2025
Mailing address303 W Ross St, Troy, OH 45373-3931

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Kettering Independent Medical Group Inc — 700 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Beavercreek