Healthcare Provider Details

I. General information

NPI: 1144827643
Provider Name (Legal Business Name): ADDIE TYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MCKNIGHT EAST DR STE 102
PITTSBURGH PA
15237-6422
US

IV. Provider business mailing address

8650 BABCOCK BLVD
PITTSBURGH PA
15237-5009
US

V. Phone/Fax

Practice location:
  • Phone: 412-295-6734
  • Fax: 412-837-1290
Mailing address:
  • Phone: 412-283-6107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH005847
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-125942
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: