Provider Demographics
NPI:1821738493
Name:TYSON, CYNTHIA (PHD, MSW, LSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:PHD, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7696 SILVER FOX DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1835
Mailing Address - Country:US
Mailing Address - Phone:614-893-4009
Mailing Address - Fax:
Practice Address - Street 1:1250 CHAMBERS RD STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1755
Practice Address - Country:US
Practice Address - Phone:614-489-8759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.18022336711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical