Provider Demographics
NPI:1396038626
Name:ANDRUS, TYLER (LCSW)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 S 900 E STE 150
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3944
Mailing Address - Country:US
Mailing Address - Phone:435-248-2089
Mailing Address - Fax:
Practice Address - Street 1:4465 S 900 E STE 150
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84124-3944
Practice Address - Country:US
Practice Address - Phone:435-248-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7353510-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical