Tyler Maxwell Dority, PHD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP6328 Issued in MN

Practice address

12 Civic Center PLZ Ste 1615
Mankato, MN 56001-7783

Phone

(507) 345-4679

NPI assigned

Nov 6, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Inspire Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Montgomery, MN
  • NPI 1134691975

  Multi-Specialty

  Medicare reassignment NPD
• Addictions and Stress Clinics LTD

  • Psychologist
  • Mankato, MN
  • NPI 1376820118

  Clinical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1104394212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 CIVIC CENTER PLZ STE 1615",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017783",
            "telephone_number": "507-345-4679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 CIVIC CENTER PLZ STE 1615",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017783",
            "telephone_number": "507-345-4679"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32298 State Highway 13",
            "address_purpose": "LOCATION",
            "city": "Montgomery",
            "state": "MN",
            "postal_code": "560694348",
            "country_code": "US",
            "telephone_number": "507-364-5312",
            "fax_number": "507-364-5908",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "922 Swift St",
            "address_purpose": "LOCATION",
            "city": "Saint Peter",
            "state": "MN",
            "postal_code": "560821844",
            "country_code": "US",
            "telephone_number": "507-364-5312",
            "fax_number": "507-364-5908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DORITY",
        "first_name": "TYLER",
        "middle_name": "MAXWELL",
        "name_prefix": "Dr.",
        "credential": "PHD, LP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-06",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP6328",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "MN",
            "license": "LP6328",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Anne Doherty
• Lauren Marie Dolly, PHARM.D.
• Emily Marie Domeier, RN
• Tessa Donato
• Jennifer Donkin
• Callah Hope Dornfeld
• Prabhjot Grace Dosanjh, M.D.
• Kaylee Dougall, M.S. CCC-SLP
• Douglas W Burgess DDS PA
• Faith Douglas

• Clinical Psychologist in Mankato, MN
• Providers in Mankato, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.