Individual
TYLER JORDAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14301 EWING AVE S, BURNSVILLE, MN 55306-4885
(952) 746-5350
Mailing address
4198 W 135TH ST, SAVAGE, MN 55378-2019
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
Other
Enumeration date
05/16/2020
Last updated
05/16/2020
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