Individual
ELIZABETH TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
210 SE 1ST ST, PRYOR, OK 74361-3606
(918) 256-7518
(918) 256-6771
Mailing address
PO BOX 912, VINITA, OK 74301-0912
(918) 256-7518
(918) 256-6771
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316001563
—
OK
Enumeration date
04/09/2015
Last updated
07/11/2016
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