Provider Demographics
NPI:1760462923
Name:TYNES, KATHERINE MORROW (LCSW LMFT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MORROW
Last Name:TYNES
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 S GLENSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-883-2725
Mailing Address - Fax:417-883-5653
Practice Address - Street 1:2021 S WAVERLY AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-883-2725
Practice Address - Fax:417-883-5653
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000420104100000X
MO300041106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11333682OtherCAQH
1760462923Medicare UPIN