Organization
TYLER PETERSEN
Active
Other names
Adult Language
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TYLER ROLLAND PETERSEN LCSW (OWNER)
(801) 919-4657
Entity
Organization
Contact information
Practice address
13351 S SHAUNNA LN, HERRIMAN, UT 84096-4706
(801) 919-4657
Mailing address
13351 S SHAUNNA LN, HERRIMAN, UT 84096-4706
(801) 919-4657
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
03/04/2021
Last updated
03/04/2021
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