Provider Demographics
NPI:1760650667
Name:TYNAN, JOSHUA (MA, LLP)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:TYNAN
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1647
Mailing Address - Country:US
Mailing Address - Phone:313-655-4514
Mailing Address - Fax:
Practice Address - Street 1:426 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1647
Practice Address - Country:US
Practice Address - Phone:313-655-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist