Provider Demographics
NPI:1629274618
Name:TYRE, JONI C (LMHC)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:C
Last Name:TYRE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:C
Other - Last Name:SMITHSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:PEACE RIVER CENTER
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-1559
Mailing Address - Country:US
Mailing Address - Phone:863-519-0575
Mailing Address - Fax:863-519-0728
Practice Address - Street 1:1835 N GILMORE AVENUE
Practice Address - Street 2:PEACE RIVER CENTER
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:863-519-0570
Practice Address - Fax:863-582-9251
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002151000Medicaid