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DR. MARY DOLORES TYLL PHD ABPP MSCP NPI 1356498919


NPI Information

NPI: 1356498919
Provider Name: DR. MARY DOLORES TYLL, PHD ABPP MSCP
Classification: Psychologist - 103TC0700X
Entity Type: Individual

Specialization: Clinical

PECOS Registration: Yes

Address:
CROWNPOINT HEALTHCARE FACILITY/NEW HORIZON WELLNESS CTR
HWY 371 & NAVAJO ROUTE 9
CROWNPOINT, NM
ZIP 87313
Phone: (505) 786-6309
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DR. Mary Dolores Tyll, PHD ABPP MSCP is a clinical psychologist in Crownpoint, NM. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. DR. Mary Dolores Tyll, PHD ABPP MSCP NPI is 1356498919. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

CROWNPOINT HEALTHCARE FACILITY/NEW HORIZON WELLNESS CTR
HWY 371 & NAVAJO ROUTE 9
CROWNPOINT, NM
ZIP 87313-358
Phone: (505) 786-6309
Fax: (505) 786-2519

The NPI 1356498919 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 1/5/2007 and was last updated on 11/27/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TC0700XPsychologistClinical1310NEW MEXICONo
2103TC0700XPsychologistClinicalPY 6142FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11310OTHERNEW MEXICONM BOARD OF PSYCHOLOGIST EXAMINERS-PSYCHOLOGY
2PY6142OTHERFLORIDAFLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE-PSYCHOLOGY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.