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KELLY SEGRAVES TYSON M.S.
NPI 1164769261
Counselor - Mental Health in Grovetown, GA

Active since January 09, 2013
3913 GRIESE LN, GROVETOWN, GA 30813(706) 877-1011 Get Directions Write a Review

NPPES record last updated: April 30, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Kelly Segraves Tyson M.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY SEGRAVES TYSON M.S. (NPI 1164769261) is an individual mental health provider in Grovetown, Georgia, licensed in Georgia (APC003687) and active in the NPI registry since January 2013.

NPPES Registry Identity

NPI1164769261
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKELLY SEGRAVES TYSONCredential: M.S.
Location Address3913 GRIESE LNGrovetown, GA 30813-8301
Mailing Address3913 Griese LnGrovetown, GA 30813-8301
Phone(706) 877-1011
Sole ProprietorYes
Enumeration DateJanuary 9, 2013
Last NPPES UpdateApril 30, 2015
✔ NPI 1164769261 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in GA · APC003687
3913 GRIESE LN, Grovetown, GA 30813
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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 Kelly Tyson's NPI number?

The NPI number for Kelly Tyson is 1164769261. It was assigned to this individual provider in the NPPES registry on January 9, 2013.

Where is Kelly Tyson located?

Kelly Tyson practices at 3913 Griese Ln, Grovetown, GA 30813. The listed phone number is (706) 877-1011.

What is Kelly Tyson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Kelly Tyson was last updated on April 30, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.