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NPI Code Detail

MEDICARE: MR. TYRONE CHARLES LPC

MEDICARE:  MR. TYRONE  CHARLES  LPC
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 Counselor96AK

General Provider Information

NPI Number : 1740201391
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TYRONE CHARLES LPC
Provider Business Mailing Address
First Line : 4325 LAUREL ST
Second Line : SUITE 245
City : ANCHORAGE
State : AK
Zip : 99508-5338
Country : US
Telephone Number : 907-562-4606
Fax Number : 907-562-4608
Provider Business Practice Location Address
First Line : 4325 LAUREL ST
Second Line : SUITE 245
City : ANCHORAGE
State : AK
Zip : 99508-5338
Country : US
Telephone Number : 907-562-4606
Fax Number : 907-562-4608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 07/08/2007

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Directions to “ MR. TYRONE CHARLES LPC” Practice Location

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