Provider Demographics
NPI:1457863516
Name:THYSELL, TANDREA
Entity Type:Individual
Prefix:MRS
First Name:TANDREA
Middle Name:
Last Name:THYSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E CANAL DR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-3936
Mailing Address - Country:US
Mailing Address - Phone:209-594-2765
Mailing Address - Fax:
Practice Address - Street 1:2513 YOUNGSTOWN RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-9707
Practice Address - Country:US
Practice Address - Phone:209-667-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF84209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional