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NPI Code Detail

MEDICARE: DAVID PHILLIP TYREE

MEDICARE: DAVID PHILLIP TYREE
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
1390200000XStudent in an Organized Health Care Education/Training Program
2101YM0800XMental Health CounselorMC61092865WA

General Provider Information

NPI Number : 1902404387
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID PHILLIP TYREE
Provider Business Mailing Address
First Line : 504 E 2ND AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99202-1406
Country : US
Telephone Number : 509-462-2500
Fax Number :
Provider Business Practice Location Address
First Line : 504 E 2ND AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99202-1406
Country : US
Telephone Number : 509-462-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2020
Last Update Date : 08/05/2021

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Directions to “ DAVID PHILLIP TYREE ” Practice Location

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