Provider Demographics
NPI:1144518093
Name:SMITH, TYRON S SR (MASTER'S)
Entity type:Individual
Prefix:MR
First Name:TYRON
Middle Name:S
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:MASTER'S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 S DEANE DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-5026
Mailing Address - Country:US
Mailing Address - Phone:561-692-2427
Mailing Address - Fax:
Practice Address - Street 1:1005 S DEANE DUFF AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-5026
Practice Address - Country:US
Practice Address - Phone:561-692-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor