Wallace, Diana Tyson

Wallace, Diana Tyson is an individual health care provider with primary practice located at 3737 Lander Rd , Cleveland OH 44124-5712. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Art Therapist. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Wallace, Diana Tyson can be contacted via phone (216) 831-2255.

Contact Information

Primary practice address
3737 Lander Rd Cleveland OH 44124-5712
Phone: (216) 831-2255
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X C. 1000308 Ohio
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Art Therapist 221700000X
Behavioral Health & Social Service Providers / Professional 101YP2500X E.1700151 Ohio

Profile Details

NPI number 1790027852
LBN Legal business name Wallace, Diana Tyson
Credentials ATR, PC
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 26th, 2013
Last updated Apr 10th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790027852 NPPES
Ohio MEDICAID 2871101

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