Organization
TYLER M. STARK, LCMHC, CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER M STARK LCMHC (OWNER)
(801) 948-0939
Entity
Organization
Contact information
Practice address
11075 S STATE ST STE 16, SANDY, UT 84070-5196
(801) 948-0939
Mailing address
11075 S STATE ST STE 16, SANDY, UT 84070-5196
(801) 948-0939
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
8598755-6004
UT
Other
Enumeration date
09/16/2016
Last updated
09/16/2016
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