Provider Demographics
NPI:1730401456
Name:HUNT, TYLER (EDS)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:HUNT
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 E HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6748
Mailing Address - Country:US
Mailing Address - Phone:480-832-3034
Mailing Address - Fax:480-832-3027
Practice Address - Street 1:230 N COLE CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4250
Practice Address - Country:US
Practice Address - Phone:480-832-3034
Practice Address - Fax:480-832-3027
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3927489103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool