Tyler Steven Poulson

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Practice address

21260 North 1450 East
Moroni, UT 84646

Phone

(435) 445-5200

Fax

(435) 445-5201

NPI assigned

Apr 18, 2012

Last updated

Apr 18, 2012By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Blue Hills Residential Treatment

  • Substance Abuse Rehabilitation Facility
  • Moroni, UT
  • NPI 1336523695
  NPD (past)
• Lighthouse Ranch Corporation

  • Substance Abuse Rehabilitation Facility
  • Ephraim, UT
  • NPI 1992079099
  NPD (past)

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

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334707200000",
    "number": "1902163678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 461",
            "city": "MORONI",
            "state": "UT",
            "postal_code": "846460461",
            "telephone_number": "435-445-5200",
            "fax_number": "435-445-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21260 NORTH 1450 EAST",
            "city": "MORONI",
            "state": "UT",
            "postal_code": "84646",
            "telephone_number": "435-445-5200",
            "fax_number": "435-445-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULSON",
        "first_name": "TYLER",
        "middle_name": "STEVEN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-18",
        "last_updated": "2012-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272503815",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jake Paxman
• Jessica Pay, AAS
• Nathan William Pay
• Todd Pay
• Steven Perkins
• Clark Randy Powell, L.C.S.W.
• Collin Kip Prisbrey
• Mark Puett
• Kenneth Corey Rawlings
• Zachary Rawlings

• Substance Abuse Rehabilitation Facility in Moroni, UT
• Providers in Moroni, UT by specialty
• Substance Abuse Rehabilitation Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; 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.