Provider Demographics
NPI:1548774557
Name:TYSON, KINDALL CHRISTENE (LPC)
Entity Type:Individual
Prefix:MS
First Name:KINDALL
Middle Name:CHRISTENE
Last Name:TYSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 SAWYER HEIGHTS ST APT 132
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-7529
Mailing Address - Country:US
Mailing Address - Phone:512-507-5351
Mailing Address - Fax:
Practice Address - Street 1:1203 S HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4818
Practice Address - Country:US
Practice Address - Phone:832-779-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YS0200X
TX74518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool