LISA M TYSON-LONG

MODESTO, CA
NPI1043518327
Former NameLISA M TYSON
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2011-03-10
Last Update Date2011-03-10
Business Address
Mrs. LISA M TYSON-LONG RAS
103 MODESTO AVE
MODESTO, CA 95354-0414
Phone number: 209-527-4597
Mailing Address
Mrs. LISA M TYSON-LONG RAS
103 MODESTO AVE
MODESTO, CA 95354-0414
Phone number: 209-527-4597
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