Healthcare Provider Details

I. General information

NPI: 1356633143
Provider Name (Legal Business Name): TYLER J ANDERSON MD, MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 N MILLER CAMPUS DR
LEHI UT
84048-7233
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-3604
  • Fax: 385-531-1805
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number6219794-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6219794-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0059856
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: