Provider Demographics
NPI:1447640214
Name:TYNAN, CHAD VINCE (LMFT)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:VINCE
Last Name:TYNAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 591684
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94159-1684
Mailing Address - Country:US
Mailing Address - Phone:415-767-8565
Mailing Address - Fax:415-463-2533
Practice Address - Street 1:2211 POST ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3442
Practice Address - Country:US
Practice Address - Phone:415-767-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114286106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist