Provider Demographics
NPI:1356114342
Name:STRUXNESS, TYLER JAMES
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:JAMES
Last Name:STRUXNESS
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 1:130 ANDERSON DR APT 8
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-3562
Mailing Address - Country:US
Mailing Address - Phone:715-699-9499
Mailing Address - Fax:
Practice Address - Street 1:130 ANDERSON DR APT 8
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3562
Practice Address - Country:US
Practice Address - Phone:715-699-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty