Provider Demographics
NPI:1104097518
Name:JOSEPH, TYRA SCOTT (MCD, CCC/A)
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:SCOTT
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MCD, CCC/A
Other - Prefix:
Other - First Name:TYRA
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC/A
Mailing Address - Street 1:10740 N GESSNER DR
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:9301 PINECROFT DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3179
Practice Address - Country:US
Practice Address - Phone:281-362-1368
Practice Address - Fax:281-364-8211
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51017231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX264456YMNBMedicare PIN
TX8K5771Medicare PIN
TXP00694814Medicare PIN
TX8K5783Medicare PIN