KAREN NAOMI TYSON MA, LPCC
NPI 1104662964
Counselor - Professional in Minneapolis, MN
About Karen Naomi Tyson Ma, Lpcc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KAREN NAOMI TYSON MA, LPCC (NPI 1104662964) is an individual professional provider in Minneapolis, Minnesota, licensed in Minnesota (4466) and active in the NPI registry since July 2024. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Karen Naomi Tyson Ma, Lpcc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Karen Tyson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Saint Paul, MN 55105
- Reassigned Medicare billing, Minnesota enrollment
- 32 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Karen Tyson's NPI number?
The NPI number for Karen Tyson is 1104662964. It was assigned to this individual provider in the NPPES registry on July 2, 2024.
Where is Karen Tyson located?
Karen Tyson practices at 1100 Glenwood Ave, Minneapolis, MN 55405. The listed phone number is (612) 871-1454.
What is Karen Tyson's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Karen Tyson enrolled in Medicare?
Yes. Karen Tyson is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Karen Tyson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Karen Tyson reassigns Medicare benefits to Wild Tree Psychotherapy, LLC (Saint Paul, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Karen Tyson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Karen Tyson was last updated on August 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Karen Naomi Tyson, MA, LPCC · NPI 1104662964
Professional provider in Minneapolis, Minnesota. Individual provider, active in the CMS NPPES registry since July 2, 2024.
## Identity
- **NPI:** 1104662964 (Entity type: Individual)
- **Enumerated:** July 2, 2024
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** 4466 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 1100 GLENWOOD AVE, Minneapolis, MN 55405-1430
- **Phone:** (612) 871-1454
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Wild Tree Psychotherapy, LLC (NPI 1528451408, Saint Paul, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 21, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1104662964) · Data from the CMS NPPES public registry.