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Individual

TYA COUSINS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1130 14TH ST APT 255B, HUNTINGTON, WV 25701-4062
(304) 982-9859
Mailing address
1130 14TH ST APT 255B, HUNTINGTON, WV 25701-4062
(304) 982-9859

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
060005176
OH
390200000X
Student in an Organized Health Care Education/Training Program
I16790
KY

Other

Enumeration date
09/23/2024
Last updated
09/23/2024
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