MEDICARE: TYRA SELLERS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1871867689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRA SELLERS

Provider Business Mailing Address
First Line	:	7860 E BERRY PL STE 140
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2326
Country	:	US
Telephone Number	:	720-470-0578
Fax Number	:

Provider Business Practice Location Address
First Line	:	7860 E BERRY PL STE 140
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2326
Country	:	US
Telephone Number	:	720-470-0578
Fax Number	:

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

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/27/2012

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Directions to “ TYRA SELLERS ” Practice Location

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