Provider Demographics
NPI:1164999835
Name:TY B. ALLER, LMFT, PLLC
Entity Type:Organization
Organization Name:TY B. ALLER, LMFT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:385-200-3993
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-0583
Mailing Address - Country:US
Mailing Address - Phone:385-200-3993
Mailing Address - Fax:
Practice Address - Street 1:545 W 465 N STE 130
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-8005
Practice Address - Country:US
Practice Address - Phone:385-200-3993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)