Healthcare Provider Details

I. General information

NPI: 1679967723
Provider Name (Legal Business Name): SHAWN SUZZANNE TYRAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 VISTA CIR
EASLEY SC
29642-8400
US

IV. Provider business mailing address

151 VISTA CIR
EASLEY SC
29642-8400
US

V. Phone/Fax

Practice location:
  • Phone: 864-546-1309
  • Fax:
Mailing address:
  • Phone: 864-546-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6750
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6750
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6750
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6820
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: