| Tyler Petersen | |
|
13351 S Shaunna Ln Herriman UT 84096-4706 | |
| (801) 919-4657 | |
| Not Available |
| Full Name | Tyler Petersen |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 13351 S Shaunna Ln, Herriman, Utah |
| Authorized Official Name and Position | Tyler Rolland Petersen (OWNER) |
| Authorized Official Contact | 8019194657 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Petersen 13351 S Shaunna Ln Herriman UT 84096-4706 Ph: (801) 919-4657 | Tyler Petersen 13351 S Shaunna Ln Herriman UT 84096-4706 Ph: (801) 919-4657 |
| NPI Number | 1871188557 |
|---|---|
| Provider Enumeration Date | 03/04/2021 |
| Last Update Date | 03/04/2021 |
| Certification Date | 03/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871188557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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