Provider Demographics
NPI:1992551816
Name:BREWER, TYSON BRETT (CPSS)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:BRETT
Last Name:BREWER
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W 110 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3555
Mailing Address - Country:US
Mailing Address - Phone:801-404-7145
Mailing Address - Fax:
Practice Address - Street 1:3784 W VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILLS
Practice Address - State:UT
Practice Address - Zip Code:84062-8085
Practice Address - Country:US
Practice Address - Phone:801-407-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2071175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist