Provider Demographics
NPI:1760009815
Name:AUNGST, TYESE LORRAINE (CADC)
Entity Type:Individual
Prefix:
First Name:TYESE
Middle Name:LORRAINE
Last Name:AUNGST
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:STOCKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18083-0442
Mailing Address - Country:US
Mailing Address - Phone:484-353-4076
Mailing Address - Fax:
Practice Address - Street 1:241 N 13TH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3211
Practice Address - Country:US
Practice Address - Phone:610-253-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8881101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)