MEDICARE: TYSON JAMES CONNER MA, LMHC

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
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	LH60735609	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427465798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYSON JAMES CONNER MA, LMHC

Provider Business Mailing Address
First Line	:	19730 64TH AVE W STE 301
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5957
Country	:	US
Telephone Number	:	206-234-1905
Fax Number	:	206-785-1689

Provider Business Practice Location Address
First Line	:	19730 64TH AVE W STE 301
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5957
Country	:	US
Telephone Number	:	206-234-1905
Fax Number	:	206-785-1689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	04/09/2020

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