Tyler Petersen

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

TYLER PETERSEN

Practice address

13351 S Shaunna LN
Herriman, UT 84096-4706

Phone

(801) 919-4657

NPI assigned

Mar 4, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Tyler Rolland Petersen, LCSWNPI 1770960452

Title

Owner

Phone

(801) 919-4657

Specialties & licenses 1

Addresses

Other names 1

• Adult Language Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tyler Rolland Petersen, CSW

  • Clinical Social Worker
  • Herriman, UT
  • NPI 1770960452
  NPD Authorized official

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1871188557",
    "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": "801-919-4657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13351 S SHAUNNA LN",
            "city": "HERRIMAN",
            "state": "UT",
            "postal_code": "840964706",
            "telephone_number": "801-919-4657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLER PETERSEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "ROLLAND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-919-4657",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adult Language",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• TM Services LLC
• Rachel Leila Tobler, LMT
• Haley Todd, LCSW
• Grace Truax, ATC
• Skyler Cole Trujillo
• Timothie Jessica Unick
• Utah CVS Pharmacy LLC (CVS Pharmacy # 10308)
• Utah Dental Health Professionals, P.C. (Boulder Corridor Dental Care)
• Elise Shanthani Vadiveloo
• Gerald Brennon Van Wie, PHARMD

• Adult Mental Health Clinic/Center in Herriman, UT
• Providers in Herriman, UT by specialty
• Adult Mental Health Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; 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.