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NPI Code Detail

MEDICARE: TYLER JOHNSON FYOTEK TLMHC, NCC

MEDICARE: TYLER JOHNSON FYOTEK TLMHC, NCC
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
1101YM0800XMental Health Counselor105877IA

General Provider Information

NPI Number : 1295496529
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER JOHNSON FYOTEK TLMHC, NCC
Provider Business Mailing Address
First Line : 221 E COLLEGE ST STE 211
Second Line :
City : IOWA CITY
State : IA
Zip : 52240-1759
Country : US
Telephone Number : 530-520-5046
Fax Number :
Provider Business Practice Location Address
First Line : 221 E COLLEGE ST STE 211
Second Line :
City : IOWA CITY
State : IA
Zip : 52240-1759
Country : US
Telephone Number : 530-520-5046
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2022
Last Update Date : 01/08/2022

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