| Tyler Buckhout, Licsw, Llc | |
|
14 Haynes St Unit 101 East Boston MA 02128-4952 | |
| (617) 863-0096 | |
| Not Available |
| Full Name | Tyler Buckhout, Licsw, Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 14 Haynes St Unit 101, East Boston, Massachusetts |
| Authorized Official Name and Position | Tyler S Buckhout (OWNER) |
| Authorized Official Contact | 9783874404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Buckhout, Licsw, Llc 14 Haynes St Unit 101 East Boston MA 02128-4952 Ph: (978) 387-4404 | Tyler Buckhout, Licsw, Llc 14 Haynes St Unit 101 East Boston MA 02128-4952 Ph: (617) 863-0096 |
| NPI Number | 1760253058 |
|---|---|
| Provider Enumeration Date | 01/15/2024 |
| Last Update Date | 01/15/2024 |
| Certification Date | 01/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760253058 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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