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General NPI Number Information
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NPI Number | 1992078091
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Entity Type | Individual
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Provider Name | SARA ELIZABETH TYNER
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Gender | Female
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 932 ROBINSON ST
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-2766
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Country | US
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Telephone | 765-790-3186
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Fax |
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Provider Business Mailing Address
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Address Line | 932 ROBINSON ST
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-2766
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Country | US
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Telephone | 765-790-3186
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1678
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 35002005A
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License Number State | IN
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