Provider Demographics
NPI:1447141387
Name:TYSON, ERIN (MED, LMHC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 LANDRUM LN STE 204
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3838
Mailing Address - Country:US
Mailing Address - Phone:904-834-7581
Mailing Address - Fax:904-834-7559
Practice Address - Street 1:183 LANDRUM LN STE 204
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3838
Practice Address - Country:US
Practice Address - Phone:904-834-7581
Practice Address - Fax:904-834-7559
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH25906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health