Provider Demographics
NPI:1770306383
Name:SKINNELL, TYNISHA L (LPC-A)
Entity type:Individual
Prefix:
First Name:TYNISHA
Middle Name:L
Last Name:SKINNELL
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:TYNISHA
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6502 BANDERA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1445
Mailing Address - Country:US
Mailing Address - Phone:210-769-3811
Mailing Address - Fax:210-634-2517
Practice Address - Street 1:6502 BANDERA RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1445
Practice Address - Country:US
Practice Address - Phone:210-769-3811
Practice Address - Fax:210-634-2517
Is Sole Proprietor?:No
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96457101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional