Provider Demographics
NPI:1225222433
Name:TYE, RONALD B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:TYE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 OVERLAND RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3073
Mailing Address - Country:US
Mailing Address - Phone:208-672-8699
Mailing Address - Fax:208-672-9308
Practice Address - Street 1:6003 OVERLAND RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3073
Practice Address - Country:US
Practice Address - Phone:208-672-8699
Practice Address - Fax:208-672-9308
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY316103TC0700X
AZPSY3208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805455300Medicaid
ID000010017563OtherBLUE SHIELD
IDN5228OtherBLUE CROSS
1194837351OtherGROUP NPI
ID1681100Medicare PIN
IDN5228OtherBLUE CROSS