MEDICARE: TYING FAMILIES TOGETHER, LLC

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
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1417314121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYING FAMILIES TOGETHER, LLC

Provider Business Mailing Address
First Line	:	1817 TURTLEDOVE DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-8510
Country	:	US
Telephone Number	:	469-486-0772
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 TURTLEDOVE DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-8510
Country	:	US
Telephone Number	:	469-486-0772
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. TYRONZA WESLEY
Credential	:	MA
Telephone Number	:	469-486-0772

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	03/11/2016

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