Individual
TYLER JUSTISE KNAUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3600 13TH ST, BAKER CITY, OR 97814-1346
(541) 523-9559
(541) 523-8067
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
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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