Provider Demographics
NPI:1477316651
Name:BLONDAL, TYRI NORMAN (LMSW)
Entity Type:Individual
Prefix:
First Name:TYRI
Middle Name:NORMAN
Last Name:BLONDAL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 E LOCKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-2255
Mailing Address - Country:US
Mailing Address - Phone:602-516-2414
Mailing Address - Fax:
Practice Address - Street 1:306 W AERO DR
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5405
Practice Address - Country:US
Practice Address - Phone:928-466-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-21985104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker