Individual
WAYNE F TYRRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SC.D.
Contact information
Practice address
82 LAKEVIEW RD, SOUTH HERO, VT 05486-4600
(802) 777-9093
Mailing address
82 LAKEVIEW RD, SOUTH HERO, VT 05486-4600
(802) 777-9093
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
4560-PY-PR
MA
Other
Enumeration date
05/11/2018
Last updated
05/11/2018
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