Provider Demographics
NPI:1306569595
Name:TYUS, KENDALL DASHUN
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:DASHUN
Last Name:TYUS
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 1:11220 WEST RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4700
Mailing Address - Country:US
Mailing Address - Phone:210-373-6017
Mailing Address - Fax:
Practice Address - Street 1:11220 WEST RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4700
Practice Address - Country:US
Practice Address - Phone:210-373-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional