Provider Demographics
NPI:1194526673
Name:TYNER, NOAH (LPC)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:TYNER
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 SPARKS LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2975
Mailing Address - Country:US
Mailing Address - Phone:254-581-9725
Mailing Address - Fax:
Practice Address - Street 1:6544 S GENERAL BRUCE DR STE A
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5811
Practice Address - Country:US
Practice Address - Phone:254-654-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health