Provider Demographics
NPI:1497221980
Name:HANSEN, TYLER SCOTT (ASUDC)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:SCOTT
Last Name:HANSEN
Suffix:
Gender:M
Credentials:ASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:996 W 800 S
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:996 W 800 S
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2766
Practice Address - Country:US
Practice Address - Phone:801-465-5111
Practice Address - Fax:801-465-7762
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10393114-6018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10393114-6018OtherCERTIFIED ADVANCED SUBSTANCE USE DISORDER COUNSELOR