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NPI Code Detail

MEDICARE: MS. KATELIN E TYSON

MEDICARE: MS. KATELIN E TYSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist91617CA

General Provider Information

NPI Number : 1225341670
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATELIN E TYSON
Provider Business Mailing Address
First Line : 3671 BUSINESS DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95820-2197
Country : US
Telephone Number : 916-889-6805
Fax Number : 916-734-5520
Provider Business Practice Location Address
First Line : 3671 BUSINESS DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95820-2197
Country : US
Telephone Number : 916-889-6805
Fax Number : 916-734-5520
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2010
Last Update Date : 01/03/2022

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Directions to “ MS. KATELIN E TYSON ” Practice Location

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