Provider Demographics
NPI:1790041135
Name:TYERMAN, CHRISTINA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNN
Last Name:TYERMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 PADDLE DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3460
Mailing Address - Country:US
Mailing Address - Phone:817-366-5385
Mailing Address - Fax:
Practice Address - Street 1:513 PADDLE DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3460
Practice Address - Country:US
Practice Address - Phone:817-366-5385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional