Brent Andrew Tycksen Jr., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10535183-3501 Issued in UT

Practice address

5600 North 250 West
Provo, UT 84604

Phone

(801) 226-4600

NPI assigned

Apr 15, 2016

Sex

Male

Sole proprietor

No

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)

Enrolled

State licenses

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

{
    "created_epoch": "1460678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1962856930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 E 10000 S",
            "city": "SALEM",
            "state": "UT",
            "postal_code": "846539253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 NORTH 250 WEST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84604",
            "telephone_number": "801-226-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 N Freedom Blvd",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846011677",
            "country_code": "US",
            "telephone_number": "801-373-4760",
            "fax_number": "801-373-0639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TYCKSEN",
        "first_name": "BRENT",
        "middle_name": "ANDREW",
        "name_suffix": "Jr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-15",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "10535183-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth C. Tuttle, PH.D.
• Valene Tuttle
• Rachel Twelmeyer
• Abby Twitchell
• Two Leaves Midwifery, LLC
• Tynaco LLC
• Jennifer Marissa Tzorin
• Elisabeth Anne Uasilaa
• Rachael Uchytil
• Lily Cate Udall

• Clinical Social Worker in Provo, UT
• Providers in Provo, 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 Oct 23, 2023; 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.