Healthcare Provider Details

I. General information

NPI: 1124711890
Provider Name (Legal Business Name): TYLER FLOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 STONERIDGE DR
BOZEMAN MT
59718-7042
US

IV. Provider business mailing address

2001 STADIUM DR STE A
BOZEMAN MT
59715-0617
US

V. Phone/Fax

Practice location:
  • Phone: 406-624-6599
  • Fax: 888-336-0944
Mailing address:
  • Phone: 406-624-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-PCLC-LIC-89348
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: