Provider Demographics
NPI:1457726762
Name:TYRRELL, ANNA (MED, LSW, LPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:MED, LSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1141
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44061-1141
Mailing Address - Country:US
Mailing Address - Phone:440-476-2958
Mailing Address - Fax:
Practice Address - Street 1:10 W ERIE ST STE 201
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3270
Practice Address - Country:US
Practice Address - Phone:440-953-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC5585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional