Provider Demographics
NPI:1821565219
Name:TYUS, DENISE RENEE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:TYUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30280 KINGSWAY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1648
Mailing Address - Country:US
Mailing Address - Phone:248-521-6432
Mailing Address - Fax:248-862-5573
Practice Address - Street 1:30280 KINGSWAY DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1648
Practice Address - Country:US
Practice Address - Phone:248-521-6432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional