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Tyler Lee Johnson-root
Peer Specialist in Vinita, Oklahoma
NPI 1144982604

Tyler Lee Johnson-root is a Peer Specialist based in Vinita, OK. Tyler Lee Johnson-root practices in Vinita, OK. The NPI Number for Tyler Lee Johnson-root is 1144982604 and holds a License No. (Oklahoma).

The current practice location address for Tyler Lee Johnson-root is 405 E Excelsior Ave, Vinita, OK and can be reached out via phone at 918-256-6476.

Location: 405 E Excelsior Ave, Vinita, OK, 74301-4226
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1144982604
Provider Name
Tyler Lee Johnson-root
Credential
Provider Entity Type
Individual
Gender
Male
Address
405 E Excelsior Ave, Vinita, OK, 74301-4226
Phone Number
918-256-6476
Fax Number
Provider Enumeration Date
10/12/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
405 E Excelsior Ave
City
Vinita
State
Oklahoma
Zip
74301-4226
Phone Number
918-256-6476
Fax Number
person
Provider Business Mailing Address Details
Address
405 E Excelsior Ave
City
Vinita
State
Oklahoma
Zip
74301-4226
Phone Number
918-256-6476
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
()
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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