Provider Demographics
NPI:1609513159
Name:TYSON, LEE BEAMAN (LCMHCA)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:BEAMAN
Last Name:TYSON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 EAGLE FARM DR N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1275
Mailing Address - Country:US
Mailing Address - Phone:252-883-8270
Mailing Address - Fax:
Practice Address - Street 1:3704 EAGLE FARM DR N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1275
Practice Address - Country:US
Practice Address - Phone:252-883-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health