| Doctor Name: | TYSON FABYANSKE |
| NPI Number: | 1194171736 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA, LADC |
| License Number: | 303921 |
| Business Practice Address: | 1900 Silver Lake Rd Nw Ste 110 New Brighton, MN - 551121789 |
| Business Phone Number: | 6516289566 |
| Business Fax Number: | |
| Mailing Address: | 1900 Silver Lake Rd Nw Ste 110, NEW BRIGHTON |
| State: | MN |
| Postal Code: | 551121789 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/12/2016 |
| NPI Last Update Date: | 05/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 303921 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |