Provider Demographics
NPI:1831068311
Name:TYSON, DIANE JOHNSTON (LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:JOHNSTON
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 1:1950 BUTLER PIKE UNIT 124
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1202
Mailing Address - Country:US
Mailing Address - Phone:610-331-4471
Mailing Address - Fax:
Practice Address - Street 1:1950 BUTLER PIKE UNIT 124
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1202
Practice Address - Country:US
Practice Address - Phone:610-331-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health