Provider Demographics
NPI:1679967723
Name:TYRAS, SHAWN SUZZANNE (LPC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:SUZZANNE
Last Name:TYRAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-8400
Mailing Address - Country:US
Mailing Address - Phone:864-546-1309
Mailing Address - Fax:
Practice Address - Street 1:151 VISTA CIR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-8400
Practice Address - Country:US
Practice Address - Phone:864-546-1309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6750101YP2500X, 101YM0800X, 101Y00000X
ME6820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor