Provider Demographics
NPI:1801919840
Name:RIPLEY, TYRA MARIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TYRA
Middle Name:MARIA
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 N 40TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-1428
Mailing Address - Country:US
Mailing Address - Phone:602-242-4449
Mailing Address - Fax:
Practice Address - Street 1:3120 W CHOLLA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4113
Practice Address - Country:US
Practice Address - Phone:602-896-5413
Practice Address - Fax:602-896-5420
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent