Tyler Patrick, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

7997802-3902 Issued in UT

Practice address

40 West 1250 North
3C
Logan, UT 84341

Phone

(208) 351-9687

Fax

(208) 356-4703

NPI assigned

Jan 14, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• The Wandering Therapist Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Love Strong, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Logan, UT
  • NPI 1396507869
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588636800000",
    "number": "1225214828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 BUCKINGHAM DR",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329670",
            "telephone_number": "435-227-5385",
            "fax_number": "208-356-4703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 WEST 1250 NORTH",
            "address_2": "3C",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "84341",
            "telephone_number": "208-351-9687",
            "fax_number": "208-356-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "TYLER",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-14",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "ID",
            "license": "MFTI-3914",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "7997802-3902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807372200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THE",
            "last_name": "THERAPIST",
            "middle_name": "WANDERING",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Shantell Parrish
• Kaleb Parry
• Matthew Dale Parry, O.D.
• Kendell Rayo Passey, L.C.S.W.
• Bradley George Patch, D.D.S.
• Hannah Paxton
• Mark A Payne, PT
• Gretchen Gimpel Peacock
• Peak Mental Health. LLC
• Peak Sleep Wellness LLC

• Marriage & Family Therapist in Logan, UT
• Providers in Logan, UT by specialty
• Marriage & Family Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.