Healthcare Provider Details

I. General information

NPI: 1740111848
Provider Name (Legal Business Name): TYSON LEE ALAMO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 SOUTHERN BLVD
BRONX NY
10459-2417
US

IV. Provider business mailing address

2700 112TH ST
LYNWOOD CA
90262-1720
US

V. Phone/Fax

Practice location:
  • Phone: 845-871-1000
  • Fax:
Mailing address:
  • Phone: 562-418-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: