Provider Demographics
NPI:1114193380
Name:TERRY, TYSON BRUCE
Entity Type:Individual
Prefix:MR
First Name:TYSON
Middle Name:BRUCE
Last Name:TERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E DANA DR APT C
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-9306
Mailing Address - Country:US
Mailing Address - Phone:435-590-4382
Mailing Address - Fax:
Practice Address - Street 1:2202 N MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-9791
Practice Address - Country:US
Practice Address - Phone:435-586-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical