Individual
SHAWN TYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
330 MAIN ST FL 1, HARTFORD, CT 06106-1851
(860) 778-9078
Mailing address
PO BOX 331271, WEST HARTFORD, CT 06133-1271
(860) 778-9078
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1329
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1329
—
CT
Enumeration date
10/12/2019
Last updated
10/12/2019
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