Tyler Mallory, CPS,CHW-C
Peer Specialist in Salisbury, MO. Individual provider (NPI-1).
NPI number1831998764
StatusActive
Last updated in NPPESMar 12, 2025
Details
- NPI
- 1831998764
- Entity type
- Individual (NPI-1)
- Name
- Tyler Mallory
- Credential
- CPS,CHW-C
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 12, 2025
- Certification date
- Mar 12, 2025
- Last updated
- Mar 12, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 175T00000X | Peer Specialist | 17723 | MO | Yes |
Practice location
105 S Weber AveSalisbury, MO 65281-1071
Phone 660-338-5001
Mailing address
102 W Hill StHuntsville, MO 65259-1197
Phone 660-651-9102
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