Individual
BRENT ANDREW TYCKSEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5600 NORTH 250 WEST, PROVO, UT 84604
(801) 226-4600
Mailing address
173 E 10000 S, SALEM, UT 84653-9253
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10535183-3501
UT
Other
Enumeration date
04/15/2016
Last updated
10/23/2023
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