Provider Demographics
NPI:1992921308
Name:TYNER, SUE L (MA)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:L
Last Name:TYNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 VIA MIL CUMBRES
Mailing Address - Street 2:#64
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1700
Mailing Address - Country:US
Mailing Address - Phone:858-350-3478
Mailing Address - Fax:
Practice Address - Street 1:HERITAGE CLINIC 1940 MARKET STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102
Practice Address - Country:US
Practice Address - Phone:619-233-3381
Practice Address - Fax:619-236-8240
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist