Provider Demographics
NPI:1730449901
Name:TYNES AND ASSOCIATES, LLC
Entity type:Organization
Organization Name:TYNES AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TYNES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:417-883-2725
Mailing Address - Street 1:2021 S WAVERLY AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2400
Mailing Address - Country:US
Mailing Address - Phone:417-883-2725
Mailing Address - Fax:417-883-5653
Practice Address - Street 1:2021 S WAVERLY AVE STE 700
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2400
Practice Address - Country:US
Practice Address - Phone:417-883-2725
Practice Address - Fax:417-883-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000420251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3382OtherMEDICARE PTAN