Provider Demographics
NPI:1518530914
Name:TOWNSEND, TYRONE LARRY JR
Entity Type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:LARRY
Last Name:TOWNSEND
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 WESTLOOP PL STE A
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2842
Mailing Address - Country:US
Mailing Address - Phone:913-957-4303
Mailing Address - Fax:
Practice Address - Street 1:205 S 4TH ST STE 207
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6166
Practice Address - Country:US
Practice Address - Phone:785-491-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC-03826101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health