Provider Demographics
NPI:1316689003
Name:PITTS, TYSON (LCSW)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:
Last Name:PITTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4282 N 3300 E
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:UT
Mailing Address - Zip Code:84310-9706
Mailing Address - Country:US
Mailing Address - Phone:801-690-4556
Mailing Address - Fax:
Practice Address - Street 1:4282 N 3300 E
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:UT
Practice Address - Zip Code:84310-9706
Practice Address - Country:US
Practice Address - Phone:801-690-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical