Provider Demographics
NPI:1467789081
Name:TYSON, MATTHEW (MA, BCBA, LBS, CLC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:TYSON
Suffix:
Gender:M
Credentials:MA, BCBA, LBS, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RATHTON ROAD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403
Mailing Address - Country:US
Mailing Address - Phone:717-885-5906
Mailing Address - Fax:717-600-8179
Practice Address - Street 1:1 RATHTON ROAD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403
Practice Address - Country:US
Practice Address - Phone:717-885-5906
Practice Address - Fax:717-600-8179
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
280706174N00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174N00000XOther Service ProvidersLactation Consultant, Non-RN