Provider Demographics
NPI:1750800611
Name:TYRRELL, CHARLES CHRISTIAN II
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CHRISTIAN
Last Name:TYRRELL
Suffix:II
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 1:8170 W SAHARA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1981
Mailing Address - Country:US
Mailing Address - Phone:702-906-1330
Mailing Address - Fax:
Practice Address - Street 1:8170 W SAHARA AVE STE 203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1981
Practice Address - Country:US
Practice Address - Phone:702-906-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician