MEDICARE: TYLER FARNES ACMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	13190209-6009	UT

General Provider Information

NPI Number	:	1154180057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER FARNES ACMHC

Provider Business Mailing Address
First Line	:	251 S MOUNTAIN RD STE 1
Second Line	:
City	:	FRUIT HEIGHTS
State	:	UT
Zip	:	84037-2371
Country	:	US
Telephone Number	:	801-643-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 S MOUNTAIN RD STE 1
Second Line	:
City	:	FRUIT HEIGHTS
State	:	UT
Zip	:	84037-2371
Country	:	US
Telephone Number	:	801-643-2030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	03/14/2024

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