Individual
MR. TYSON JAYE SAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA, AA PSYCH
Contact information
Practice address
400 GOLD AVE SW STE 1200, ALBUQUERQUE, NM 87102-3276
(505) 200-1654
Mailing address
400 GOLD AVE SW STE 1200, ALBUQUERQUE, NM 87102-3276
(505) 200-1654
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CTB-2026-0225
NM
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/16/2009
Last updated
04/22/2026
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