Provider Demographics
NPI:1932310323
Name:TYNDALL, LISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E 10TH ST
Mailing Address - Street 2:ECU FAMILY THERAPY CLINIC
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-3411
Mailing Address - Country:US
Mailing Address - Phone:252-737-1415
Mailing Address - Fax:
Practice Address - Street 1:612 E 10TH ST
Practice Address - Street 2:ECU FAMILY THERAPY CLINIC
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-3411
Practice Address - Country:US
Practice Address - Phone:252-737-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist