Provider Demographics
NPI:1407109192
Name:PURDY, TYLER STEPHEN
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:STEPHEN
Last Name:PURDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7943 N PEREGRINE CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4177
Mailing Address - Country:US
Mailing Address - Phone:801-310-3315
Mailing Address - Fax:
Practice Address - Street 1:28 S 850 E
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4516
Practice Address - Country:US
Practice Address - Phone:801-736-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8625239-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical