Provider Demographics
NPI:1295453306
Name:TYREE, HUNTER LEE
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:LEE
Last Name:TYREE
Suffix:
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 1:2211 W CARY ST APT A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-5242
Mailing Address - Country:US
Mailing Address - Phone:704-780-8813
Mailing Address - Fax:
Practice Address - Street 1:2211 W CARY ST APT A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-5242
Practice Address - Country:US
Practice Address - Phone:704-780-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty