Ty Bracken Aller
Individual provider Active NPI Marriage & Family Therapist · Providence, UT
NPI 1386119600 · NPPES record last updated Oct 29, 2018
Key facts
- NPI
- 1386119600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 9560142-3902 (UT)
- Practice address
- 545 W 465 N Ste 130
Providence, UT 84332-8005 - Phone
- (385) 200-3993
- NPI assigned
- Oct 13, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9560142-3902 | UT | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ty B. Aller, LMFT, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 9560142-3902 | UT | Yes |
Addresses
Primary practice location
545 W 465 N Ste 130
Providence, UT 84332-8005
Mailing address
PO Box 583
Providence, UT 84332-0583
Other providers in Providence, UT
- Cayden Emma Albiston
- Andrew Alexander
- Stanton Cannon Allen
- Talon Allen
- Allencrane, LLP
- Gregory J Allred
- Heather B Allred
- Darren V Anderson
- Kent W Anderson
- Angel Home Hospice LLC
All providers in Providence, UT · Marriage & Family Therapist in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.