Individual
TYLER BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
521 W LOTT ST, BUFFALO, WY 82834-1642
(307) 684-5531
(307) 684-2912
Mailing address
909 LONG DR STE C, SHERIDAN, WY 82801-3282
(307) 672-8958
(307) 672-8950
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PPC721
WY
101YP2500X
Professional Counselor
Primary
LPC-1434
WY
Other
Enumeration date
12/07/2012
Last updated
07/09/2019
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