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NPI Code Detail

MEDICARE: JADE ENRIQUE TYUS

MEDICARE: JADE ENRIQUE TYUS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorAPC010613GA

General Provider Information

NPI Number : 1417377888
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADE ENRIQUE TYUS
Provider Business Mailing Address
First Line : 447 SUTTER ST STE 405
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94108-4618
Country : US
Telephone Number : 415-992-6155
Fax Number :
Provider Business Practice Location Address
First Line : 500 FAIRWAY DR STE 102
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33441-1817
Country : US
Telephone Number : 888-880-9270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2014
Last Update Date : 01/13/2026

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Directions to “ JADE ENRIQUE TYUS ” Practice Location

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