| Doctor Name: | MR. TYSON BRUCE TERRY |
| NPI Number: | 1114193380 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 2202 N Main St Ste 301 Cedar City, UT - 847209791 |
| Business Phone Number: | 4355864479 |
| Business Fax Number: | |
| Mailing Address: | 402 E Dana Dr Apt C, CEDAR CITY |
| State: | UT |
| Postal Code: | 847209306 |
| Phone Number: | 4355904382 |
| Fax Number: | |
| NPI Enumeration Date: | 05/07/2008 |
| NPI Last Update Date: | 05/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |