Provider Demographics
NPI:1124756267
Name:KAY, TYRONE JON (LADAC)
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:JON
Last Name:KAY
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W NIZHONI BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5766
Mailing Address - Country:US
Mailing Address - Phone:505-722-9470
Mailing Address - Fax:505-722-9570
Practice Address - Street 1:300 W NIZHONI BLVD STE A
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5766
Practice Address - Country:US
Practice Address - Phone:505-722-9470
Practice Address - Fax:505-722-9570
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAD0225331101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)