Provider Demographics
NPI:1710971114
Name:TYNDALL, LARRY WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WILLIAM
Last Name:TYNDALL
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 1:15450 IRON HORSE CIR
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3852
Mailing Address - Country:US
Mailing Address - Phone:913-499-4300
Mailing Address - Fax:
Practice Address - Street 1:12701 METCALF AVE STE 204
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2854
Practice Address - Country:US
Practice Address - Phone:913-499-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR 0306103T00000X
KSLP 0773103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0009981Medicare ID - Type UnspecifiedPROVIDER NUMBER
KSS95D941Medicare ID - Type UnspecifiedPERFORMING PROVIDER #