Provider Demographics
NPI:1265818801
Name:TYSON, TESSA LEE (LMFT, MMFT)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:LEE
Last Name:TYSON
Suffix:
Gender:F
Credentials:LMFT, MMFT
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:LEE
Other - Last Name:IACONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, MMFT
Mailing Address - Street 1:1035 14TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3050
Mailing Address - Country:US
Mailing Address - Phone:615-327-9400
Mailing Address - Fax:
Practice Address - Street 1:1035 14TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3050
Practice Address - Country:US
Practice Address - Phone:615-327-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1202106H00000X
AZLMFT-10403106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist