MEDICARE: TYRI HAYNIE

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
1	106S00000X	Behavior Technician
2	101Y00000X	Counselor		CA

General Provider Information

NPI Number	:	1720693526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRI HAYNIE

Provider Business Mailing Address
First Line	:	6622 N MAROA AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-1209
Country	:	US
Telephone Number	:	559-575-8172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 E SHAW AVE STE 149
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-7903
Country	:	US
Telephone Number	:	559-554-9710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	01/08/2025

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Directions to “ TYRI HAYNIE ” Practice Location

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