Tyler M. Stark, Lcmhc, Corp. | |
11075 S State St Ste 16 Sandy UT 84070-5196 | |
(801) 948-0939 | |
Not Available |
Full Name | Tyler M. Stark, Lcmhc, Corp. |
---|---|
Speciality | Community/behavioral Health |
Location | 11075 S State St Ste 16, Sandy, Utah |
Authorized Official Name and Position | Tyler M Stark (OWNER) |
Authorized Official Contact | 8019480939 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Tyler M. Stark, Lcmhc, Corp. 11075 S State St Ste 16 Sandy UT 84070-5196 Ph: (801) 948-0939 | Tyler M. Stark, Lcmhc, Corp. 11075 S State St Ste 16 Sandy UT 84070-5196 Ph: (801) 948-0939 |
NPI Number | 1083162226 |
---|---|
Provider Enumeration Date | 09/16/2016 |
Last Update Date | 09/16/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083162226 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 8598755-6004 (Utah) | Primary |
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