Provider Demographics
NPI:1235935156
Name:TYSON, LAURA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TYSON
Suffix:
Gender:
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BAKERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1500
Mailing Address - Country:US
Mailing Address - Phone:304-598-4300
Mailing Address - Fax:
Practice Address - Street 1:201 BAKERS RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1500
Practice Address - Country:US
Practice Address - Phone:304-598-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1-24-75010103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst