Provider Demographics
NPI:1528309903
Name:THOMPSON HUGHES, TYRA (MED)
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:
Last Name:THOMPSON HUGHES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 W DESERT INN RD
Mailing Address - Street 2:102-469
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2904 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5015
Practice Address - Country:US
Practice Address - Phone:702-292-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NV96889101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool