Tyjean Green

Individual provider Active NPI Behavior Technician · Box Elder, SD

NPI 1134099146 · NPPES record last updated Nov 6, 2025

Key facts

NPI
1134099146
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
404 Berky Dr
Box Elder, SD 57719-8049
Phone
(541) 340-4210
NPI assigned
Nov 6, 2025
Sex
Unspecified or another gender identity
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

404 Berky Dr
Box Elder, SD 57719-8049

Mailing address

404 Berky Dr
Box Elder, SD 57719-8049

Other providers in Box Elder, SD

All providers in Box Elder, SD · Behavior Technician in South Dakota

Sources for this page

Verify at the official NPI Registry.