| Doctor Name: | MR. TYLER ROLLAND PETERSEN |
| NPI Number: | 1770960452 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CSW |
| License Number: | 5919098-3502 |
| Business Practice Address: | 13351 S Shaunna Lane Herriman, UT - 84096 |
| Business Phone Number: | 8019156055 |
| Business Fax Number: | |
| Mailing Address: | 13351 S Shaunna Ln, HERRIMAN |
| State: | UT |
| Postal Code: | 840964706 |
| Phone Number: | 8019156055 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2015 |
| NPI Last Update Date: | 05/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 5919098-3502 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |