Provider Demographics
NPI:1366928889
Name:TYNES, BRIA DANIELLE (MS, LPC CANDIDATE)
Entity type:Individual
Prefix:
First Name:BRIA
Middle Name:DANIELLE
Last Name:TYNES
Suffix:
Gender:F
Credentials:MS, LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 TIMBER RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-0620
Mailing Address - Country:US
Mailing Address - Phone:580-229-3870
Mailing Address - Fax:
Practice Address - Street 1:905 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1216
Practice Address - Country:US
Practice Address - Phone:580-226-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor