Provider Demographics
NPI:1598363962
Name:TYREK J PRATT LLC
Entity type:Organization
Organization Name:TYREK J PRATT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TYREK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:860-365-1310
Mailing Address - Street 1:74 NEW LONDON TPKE STE 1
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4204
Mailing Address - Country:US
Mailing Address - Phone:860-365-1310
Mailing Address - Fax:
Practice Address - Street 1:74 NEW LONDON TPKE STE 1
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4204
Practice Address - Country:US
Practice Address - Phone:860-365-1310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty