Tyler Broderick, MS, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-1434 Issued in WY

Practice address

521 W Lott St
Buffalo, WY 82834-1642

Phone

(307) 684-5531

Fax

(307) 684-2912

NPI assigned

Dec 7, 2012

Last updated

Jul 9, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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

• Volunteers of America Northern Rockies

  • Substance Abuse Rehabilitation Facility
  • Sheridan, WY
  • NPI 1689249682
  NPD

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

{
    "created_epoch": "1354838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1396080917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 LONG DR STE C",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828013282",
            "telephone_number": "307-672-8958",
            "fax_number": "307-672-8950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W LOTT ST",
            "city": "BUFFALO",
            "state": "WY",
            "postal_code": "828341642",
            "telephone_number": "307-684-5531",
            "fax_number": "307-684-2912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "TYLER",
        "credential": "MS, LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-07",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WY",
            "license": "PPC721",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WY",
            "license": "LPC-1434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Collin G Beecher, MS, NCC, LPC
• Julia M. Bettinger, M.S.
• Bidonde Family Practice, LLC
• Black Tooth Physiotherapy Performance, LLC
• Timothy A Blaney, PSY.D.
• Buffalo Chiropractic LLC (Loyd Chiropractic center)
• Buffalo Family Chiropractic, LLC
• Buffalo Prescription Shop, Inc
• Buffalo Senior Center, Inc.
• Buffalo Urgent Care Inc

• Professional Counselor in Buffalo, WY
• Providers in Buffalo, WY by specialty
• Professional Counselor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; 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.