Provider Demographics
NPI:1376787853
Name:TYSON-MARCHINO, MARY FRANCES (MFT, CSAC, RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FRANCES
Last Name:TYSON-MARCHINO
Suffix:
Gender:F
Credentials:MFT, CSAC, RPT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:FRANCES
Other - Last Name:TYSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT, CSAC, RPT
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-0339
Mailing Address - Country:US
Mailing Address - Phone:808-652-2862
Mailing Address - Fax:808-320-3933
Practice Address - Street 1:3417 POIPU RD
Practice Address - Street 2:#104
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756-8546
Practice Address - Country:US
Practice Address - Phone:808-652-2862
Practice Address - Fax:808-320-3933
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health