MEDICARE: TYS LLC DBA SOUTHWEST CONSULTING

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	251S00000X	Community/Behavioral Health Agency	32008	TX

General Provider Information

NPI Number	:	1790026359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYS LLC DBA SOUTHWEST CONSULTING

Provider Business Mailing Address
First Line	:	1402 CORINTH ST
Second Line	:	SUITE 219
City	:	DALLAS
State	:	TX
Zip	:	75215-2111
Country	:	US
Telephone Number	:	469-360-7453
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 CORINTH ST
Second Line	:	SUITE 219
City	:	DALLAS
State	:	TX
Zip	:	75215-2111
Country	:	US
Telephone Number	:	469-360-7453
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	PRISCILLA SOUZA
Credential	:	PHD
Telephone Number	:	469-360-7453

Provider Enumeration Date	:	03/07/2013
Last Update Date	:	03/07/2013

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