| Doctor Name: | KELLY SEGRAVES TYSON |
| NPI Number: | 1164769261 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. |
| License Number: | APC003687 |
| Business Practice Address: | 3913 Griese Ln Grovetown, GA - 308138301 |
| Business Phone Number: | 7068771011 |
| Business Fax Number: | |
| Mailing Address: | 3913 Griese Ln, GROVETOWN |
| State: | GA |
| Postal Code: | 308138301 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/09/2013 |
| NPI Last Update Date: | 04/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | APC003687 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |