Tyler Rolland Petersen, CSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5919098-3502 Issued in UT

Practice address

13351 S Shaunna Lane
Herriman, UT 84096

Phone

(801) 915-6055

NPI assigned

May 1, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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.

• Tyler Petersen

  • Adult Mental Health Clinic/Center
  • Herriman, UT
  • NPI 1871188557
  NPD Authorized official

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

{
    "created_epoch": "1430438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430438400000",
    "number": "1770960452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13351 S SHAUNNA LN",
            "city": "HERRIMAN",
            "state": "UT",
            "postal_code": "840964706",
            "telephone_number": "801-915-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13351 S SHAUNNA LANE",
            "city": "HERRIMAN",
            "state": "UT",
            "postal_code": "84096",
            "telephone_number": "801-915-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "TYLER",
        "middle_name": "ROLLAND",
        "name_prefix": "Mr.",
        "credential": "CSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-01",
        "last_updated": "2015-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "5919098-3502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Niraj Patel
• Deirdra Patterson, RD
• Bethany Paul
• Mallory Payan
• Andrew Payne, CAT, LAT
• Alyssa Peterson
• Naomi Helene Phillips, DC
• Dana Michelle Pickle, FNP
• Premier Orthodontic Care
• Kent Austin Prewett

• Clinical Social Worker in Herriman, UT
• Providers in Herriman, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; 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.