Provider Demographics
NPI:1093445348
Name:THOMAS, TYSLEY (BHT)
Entity Type:Individual
Prefix:
First Name:TYSLEY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 E BASELINE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1453
Mailing Address - Country:US
Mailing Address - Phone:480-378-8454
Mailing Address - Fax:
Practice Address - Street 1:1204 E BASELINE RD STE 201
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1453
Practice Address - Country:US
Practice Address - Phone:480-378-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician