Provider Demographics
NPI:1538764790
Name:TYSON, MARY KATHRYN (MAPC, LPC)
Entity type:Individual
Prefix:
First Name:MARY KATHRYN
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:MAPC, LPC
Other - Prefix:
Other - First Name:MARY KATHRYN
Other - Middle Name:
Other - Last Name:DESJARDINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAPC, LPC-C
Mailing Address - Street 1:411 E DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4525
Mailing Address - Country:US
Mailing Address - Phone:919-606-6893
Mailing Address - Fax:
Practice Address - Street 1:9820 E 41ST ST STE 400
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3616
Practice Address - Country:US
Practice Address - Phone:918-641-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10918101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional