Basic Information
| Provider Information | |||||||||
| NPI: | 1205122934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TYNES | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1180 3RD AVE | ||||||||
| Address2: | SUITE C-3 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919113139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196918164 | ||||||||
| FaxNumber: | 6194262359 | ||||||||
| Practice Location | |||||||||
| Address1: | 1180 3RD AVE | ||||||||
| Address2: | SUITE C-3 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919113139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196918164 | ||||||||
| FaxNumber: | 6194262359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2011 | ||||||||
| LastUpdateDate: | 06/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.