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General NPI Number Information
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NPI Number | 1720693526
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Entity Type | Individual
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Provider Name | TYRI HAYNIE
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Gender | Male
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 1300 E SHAW AVE STE 149
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City | FRESNO
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State | CA
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Zip | 93710-7903
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Country | US
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Telephone | 559-554-9710
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Fax |
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Provider Business Mailing Address
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Address Line | 6622 N MAROA AVE
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City | FRESNO
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State | CA
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Zip | 93704-1209
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Country | US
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Telephone | 559-575-8172
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | CA
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