Organization
TYLER BUCKHOUT, LICSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER S BUCKHOUT LICSW (OWNER)
(978) 387-4404
Entity
Organization
Contact information
Practice address
14 HAYNES ST UNIT 101, EAST BOSTON, MA 02128-4952
(617) 863-0096
Mailing address
14 HAYNES ST UNIT 101, EAST BOSTON, MA 02128-4952
(978) 387-4404
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/15/2024
Last updated
01/15/2024
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