Healthcare Provider Details

I. General information

NPI: 1124856513
Provider Name (Legal Business Name): TYNE ORI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TYNE MCGEE PHD

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FORBES BLVD STE 400
LANHAM MD
20706-6331
US

IV. Provider business mailing address

3227 75TH AVE APT 303
HYATTSVILLE MD
20785-1906
US

V. Phone/Fax

Practice location:
  • Phone: 240-257-6363
  • Fax:
Mailing address:
  • Phone: 909-436-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number07220
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: