Provider Demographics
NPI:1578036612
Name:CURTIS, JOHN TYLER
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TYLER
Last Name:CURTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3211
Mailing Address - Country:US
Mailing Address - Phone:309-235-2804
Mailing Address - Fax:
Practice Address - Street 1:215 6TH AVE S STE 25
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4347
Practice Address - Country:US
Practice Address - Phone:563-242-9210
Practice Address - Fax:563-243-0730
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist