Provider Demographics
NPI:1588023618
Name:TYUS, VANESSA
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:TYUS
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 1:3367 WAINRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2055
Mailing Address - Country:US
Mailing Address - Phone:217-473-0434
Mailing Address - Fax:
Practice Address - Street 1:3367 WAINRIGHT LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2055
Practice Address - Country:US
Practice Address - Phone:217-473-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor