Provider Demographics
NPI:1770904328
Name:TYNER, ELINOR KYLE (LPC- A LICENSED PROF)
Entity type:Individual
Prefix:MRS
First Name:ELINOR
Middle Name:KYLE
Last Name:TYNER
Suffix:
Gender:F
Credentials:LPC- A LICENSED PROF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 BAYMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-9547
Mailing Address - Country:US
Mailing Address - Phone:704-876-6971
Mailing Address - Fax:877-532-0867
Practice Address - Street 1:1206 MUSEUM ROAD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625
Practice Address - Country:US
Practice Address - Phone:704-876-6971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional