Provider Demographics
NPI:1417551425
Name:TIGNER, TYRHEN
Entity type:Individual
Prefix:
First Name:TYRHEN
Middle Name:
Last Name:TIGNER
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 1:1365 E PARKS HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8297
Mailing Address - Country:US
Mailing Address - Phone:907-378-9918
Mailing Address - Fax:
Practice Address - Street 1:360 N PINE RIDGE LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-4212
Practice Address - Country:US
Practice Address - Phone:907-378-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health