Tyler Lee Johnson-Root

NPI #1144982604 in Vinita, Oklahoma

Provider Information

NPI Number: 1144982604
Entity Type: Individual
Name: Tyler Lee Johnson-Root
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Peer Specialist
Enumeration Date: Oct 12, 2021
Last Updated: Oct 12, 2021

Practice Location

Address: 405 E EXCELSIOR AVE
City: Vinita
State: Oklahoma
ZIP Code: 74301-4226
Phone: (918) 256-6476

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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