Provider Demographics
NPI:1053981878
Name:TYSON, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BUSINESS PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-7006
Mailing Address - Country:US
Mailing Address - Phone:888-417-5250
Mailing Address - Fax:
Practice Address - Street 1:106 BUSINESS PARK AVENUE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7072
Practice Address - Country:US
Practice Address - Phone:888-417-5250
Practice Address - Fax:225-341-8756
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician