MEDICARE: TYLER PETERSON

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
1	101YM0800X	Mental Health Counselor	7980-226	WI

General Provider Information

NPI Number	:	1902757685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER PETERSON

Provider Business Mailing Address
First Line	:	5413 DAY TRIPPER DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53718-4416
Country	:	US
Telephone Number	:	608-285-2493
Fax Number	:

Provider Business Practice Location Address
First Line	:	5413 DAY TRIPPER DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53718-4416
Country	:	US
Telephone Number	:	608-285-2493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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Directions to “ TYLER PETERSON ” Practice Location

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