Healthcare Provider Details

I. General information

NPI: 1730401456
Provider Name (Legal Business Name): TYLER HUNT ED.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N COLE CT
GILBERT AZ
85234-4250
US

IV. Provider business mailing address

5745 E HAMPTON AVE
MESA AZ
85206-6748
US

V. Phone/Fax

Practice location:
  • Phone: 480-832-3034
  • Fax: 480-832-3027
Mailing address:
  • Phone: 480-832-3034
  • Fax: 480-832-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3927489
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: