Most Relevant Information
Provider Data
| NPI Number: | 1003307562 |
| Provider Name: | TYLER BOULTON |
| Entity Type: | Individual |
| Taxonomy Code: | 251S00000X |
| Specialty: | Community/Behavioral Health |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/21/2018 |
| Last Updated: | 05/21/2018 |
Provider Practice Location
527 N MERIDIAN RD
YOUNGSTOWN
OH
445091227
Practice Location Phone/Fax
| Phone: | 3307970074 |
| Fax: |
Provider Mailing Location
527 N MERIDIAN RD
YOUNGSTOWN
OH
445091227
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |