Individual
MARY TYNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10748 VIRGINIA PLZ STE 107, LA VISTA, NE 68128-3265
(402) 933-4411
(888) 507-5931
Mailing address
2205 LUCILLE DR, BELLEVUE, NE 68147-2504
(402) 686-9760
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
13647
NE
101YM0800X
Mental Health Counselor
Primary
4463
NE
106S00000X
Behavior Technician
—
—
Other
Enumeration date
08/17/2020
Last updated
03/09/2026
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