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General NPI Number Information
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NPI Number | 1407109192
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Entity Type | Individual
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Provider Name | TYLER STEPHEN PURDY
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Gender | Male
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 28 S 850 E
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-4516
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Country | US
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Telephone | 801-736-0889
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Fax |
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Provider Business Mailing Address
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Address Line | 7943 N PEREGRINE CIR
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-4177
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Country | US
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Telephone | 801-310-3315
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8625239-3501
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License Number State | UT
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