| Tyler M. Stark, Lcmhc, Corp. | |
|
11075 S State St Ste 16 Sandy UT 84070-5196 | |
| (801) 948-0939 | |
| Not Available |
| Full Name | Tyler M. Stark, Lcmhc, Corp. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11075 S State St Ste 16, Sandy, Utah |
| Authorized Official Name and Position | Tyler M Stark (OWNER) |
| Authorized Official Contact | 8019480939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler M. Stark, Lcmhc, Corp. 11075 S State St Ste 16 Sandy UT 84070-5196 Ph: (801) 948-0939 | Tyler M. Stark, Lcmhc, Corp. 11075 S State St Ste 16 Sandy UT 84070-5196 Ph: (801) 948-0939 |
| NPI Number | 1083162226 |
|---|---|
| Provider Enumeration Date | 09/16/2016 |
| Last Update Date | 09/16/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083162226 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 8598755-6004 (Utah) | Primary |
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