Provider Demographics
NPI:1689759664
Name:TYRE, CHRISTOPHER THOMAS (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:TYRE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 WILLIAMSTOWNE
Mailing Address - Street 2:SUITE G
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2322
Mailing Address - Country:US
Mailing Address - Phone:262-646-6404
Mailing Address - Fax:
Practice Address - Street 1:394 WILLIAMSTOWNE
Practice Address - Street 2:SUITE G
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2322
Practice Address - Country:US
Practice Address - Phone:262-646-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2074-057103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIS57296Medicare UPIN