MR. Tyson Blake Prouse, M.S., T-LMLP

NPI #1952587792 in El Dorado, Kansas

Provider Information

NPI Number: 1952587792
Entity Type: Individual
Name: MR. Tyson Blake Prouse, M.S., T-LMLP
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Psychologist - Clinical
Credential: M.S., T-LMLP
Enumeration Date: Jan 10, 2008
Last Updated: Jan 10, 2008

Practice Location

Address: 120 S GORDY ST STE 3
City: El Dorado
State: Kansas
ZIP Code: 67042-2900
Phone: (316) 321-6088

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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