Provider Demographics
NPI:1487723706
Name:TYSON, HARRY (LCSW)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:TYSON
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 1:25 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-3149
Mailing Address - Country:US
Mailing Address - Phone:724-662-1896
Mailing Address - Fax:
Practice Address - Street 1:26 NESBITT RD STE 110
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3410
Practice Address - Country:US
Practice Address - Phone:724-657-1881
Practice Address - Fax:724-657-9178
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health