Individual
TYLER PATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
40 WEST 1250 NORTH, 3C, LOGAN, UT 84341
(208) 351-9687
(208) 356-4703
Mailing address
205 BUCKINGHAM DR, PROVIDENCE, UT 84332-9670
(435) 227-5385
(208) 356-4703
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
7997802-3902
UT
106H00000X
Marriage & Family Therapist
MFTI-3914
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807372200
—
ID
Enumeration date
01/14/2008
Last updated
05/05/2020
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