Provider Demographics
NPI:1902026842
Name:TYSON, LYNDA KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:KAY
Last Name:TYSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3296 PITCHER PLANT CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-9470
Mailing Address - Country:US
Mailing Address - Phone:850-723-6014
Mailing Address - Fax:850-492-3342
Practice Address - Street 1:3296 PITCHER PLANT CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-9470
Practice Address - Country:US
Practice Address - Phone:850-723-6014
Practice Address - Fax:850-492-3342
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health