Healthcare Provider Details

I. General information

NPI: 1629920574
Provider Name (Legal Business Name): TYRONE GIVENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 55TH ST NE
WASHINGTON DC
20019-6784
US

IV. Provider business mailing address

6613 GATEWAY BLVD
DISTRICT HEIGHTS MD
20747-2247
US

V. Phone/Fax

Practice location:
  • Phone: 202-559-2477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: