MEDICARE: HARRY TYSON LCSW

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	101YM0800X	Mental Health Counselor	CW012208	PA

General Provider Information

NPI Number	:	1487723706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY TYSON LCSW

Provider Business Mailing Address
First Line	:	25 WRIGHT ST
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-3149
Country	:	US
Telephone Number	:	724-662-1896
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 NESBITT RD STE 110
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-3410
Country	:	US
Telephone Number	:	724-657-1881
Fax Number	:	724-657-9178

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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