Provider Demographics
NPI:1689919227
Name:TYRONE, MARGIE K (LMFT)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:K
Last Name:TYRONE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 WOLCOTT LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-6091
Mailing Address - Country:US
Mailing Address - Phone:682-552-0640
Mailing Address - Fax:
Practice Address - Street 1:611 WOLCOTT LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-6091
Practice Address - Country:US
Practice Address - Phone:682-552-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-09
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201492106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist