Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 9846066-3501 | UT |
NPI | 1003268731 |
---|---|
Provider Name | Tyler Beckstrand |
First Address | Brigham City, UT 84302-2118 |
Second Address | Brigham City, UT 84302-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2016 |
Last Update Date | 22/07/2021 |