Provider Demographics
NPI:1316056724
Name:TYSON, DEBORAH J (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:J
Last Name:TYSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6228 WILLOW OAK DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-3921
Mailing Address - Country:US
Mailing Address - Phone:615-662-7979
Mailing Address - Fax:615-662-7974
Practice Address - Street 1:173B BELLE FOREST CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2103
Practice Address - Country:US
Practice Address - Phone:615-662-7979
Practice Address - Fax:615-662-7974
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1934103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3686999Medicaid
TN3686999Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER