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Individual
TYLER JUSTISE KNAUTZ
Active
Individual
TYLER JUSTISE KNAUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
PENDING
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B311170
ODL
OR
Enumeration date
02/22/2024
Last updated
02/22/2024
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