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NPI Code Detail

MEDICARE: BRAXTON VANCE TYRELL TYNES AMFT

MEDICARE: BRAXTON VANCE TYRELL TYNES AMFT
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
1106H00000XMarriage & Family TherapistCA

General Provider Information

NPI Number : 1265382782
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAXTON VANCE TYRELL TYNES AMFT
Provider Business Mailing Address
First Line : 17192 MURPHY AVE
Second Line :
City : IRVINE
State : CA
Zip : 92623-0400
Country : US
Telephone Number : 951-505-0939
Fax Number :
Provider Business Practice Location Address
First Line : 4281 KATELLA AVE STE 207
Second Line :
City : LOS ALAMITOS
State : CA
Zip : 90720-6515
Country : US
Telephone Number : 626-270-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2026
Last Update Date : 02/03/2026

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