Tyler Wayne Pack

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

15221 State Route 124
Piketon, OH 45661

Phone

(740) 505-1420

NPI assigned

Sep 20, 2019

Last updated

Sep 20, 2019By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568937600000",
    "number": "1902457062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N HIGH ST",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456011634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15221 STATE ROUTE 124",
            "city": "PIKETON",
            "state": "OH",
            "postal_code": "45661",
            "telephone_number": "740-505-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "TYLER",
        "middle_name": "WAYNE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-20",
        "last_updated": "2019-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tifany Len O'Rourke, LSW, CDCA
• Amber Ohlinger
• Cathie NMN Osborn, RN
• Debra Kay Osborne
• Melinda G Owsley
• Kari Parker, NP-C
• Pavilion at Piketon for Nursing and Rehabilitation LLC (The Pavilion at Piketon)
• Andrew Pearl, MOT, OTR/L
• Brad Allen Pendell, D.D.S., M.S.
• Brittany Lynn Pendleton, LPN

• Addiction (Substance Use Disorder) Counselor in Piketon, OH
• Providers in Piketon, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.