Individual
TYLER ROSE O'SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS ACT
Contact information
Practice address
1520 HAINES AVE STE 6, RAPID CITY, SD 57701-0710
(605) 716-7841
Mailing address
1520 HAINES AVE STE 6, RAPID CITY, SD 57701-0710
(605) 716-7841
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110119887193227889
—
SD
Enumeration date
07/09/2020
Last updated
07/09/2020
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