Provider Demographics
NPI:1255535738
Name:TYREE, ELMER DAVID JR
Entity type:Individual
Prefix:MR
First Name:ELMER
Middle Name:DAVID
Last Name:TYREE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14343 DUKE CT
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-3738
Mailing Address - Country:US
Mailing Address - Phone:951-520-5844
Mailing Address - Fax:
Practice Address - Street 1:11959 MARIPOSA RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1637
Practice Address - Country:US
Practice Address - Phone:760-956-2462
Practice Address - Fax:760-956-7542
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)