Individual
TYLER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PEER SUPPORT
Contact information
Practice address
4977 NORTHCUTT PL, DAYTON, OH 45414-3839
(800) 829-5461
Mailing address
812 N MAIN ST, MALTA, OH 43758-9019
(740) 651-7836
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
APS005364
OH
Other
Enumeration date
12/01/2021
Last updated
09/03/2024
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