Tiya Shalyse Johnson, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

S7462 Issued in TX

Practice address

11937 US Highway 271
Tyler, TX 75708-3154

Phone

(903) 877-7168

Fax

(903) 877-8355

NPI assigned

Mar 20, 2012

Last updated

Aug 17, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 10

Addresses

Medicare fee-for-service enrollment

Enrolled in KY, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tiya.johnson@hca5.eclinicaldirectplus.com
• Direct secure messaging: tjohnson346169@ahs.direct-ci.com

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

• Andrews Center

  dba Andrews Center Chemical Treatment Facility

  • Mental Health Counselor
  • Tyler, TX
  • NPI 1821064742

  Psychiatry

  Medicare reassignment NPD
• University of Texas Health Science Center at Tyler-Facility-Physician

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Tyler, TX
  • NPI 1063400778
  Medicare reassignment NPD
• New Leaf Clinic

  • Adult Mental Health Clinic/Center
  • Louisville, KY
  • NPI 1659884872
  Medicare reassignment NPD
• Psychological & Behavioral Consultants, LLC

  dba LifeStance Health

  • Psychiatry Physician
  • Beachwood, OH
  • NPI 1811915713

  KY

  Medicare reassignment NPD
• Andrews Center

  dba Chemical Treatment Facility

  • Mental Health Counselor
  • Tyler, TX
  • NPI 1205802170
  NPD
• Andrews Center -Pinkerton

  • Social Worker
  • Tyler, TX
  • NPI 1538604715
  NPD
• University of Texas Health Science Center at Tyler-Facilty-Physician

  dba UT Health East Texas Physicians Overton

  • Rural Health Clinic/Center
  • Overton, TX
  • NPI 1689496812
  NPD
• Beaumont Behavioral Health PSC

  • Psychiatric/Mental Health Nurse Practitioner
  • Lexington, KY
  • NPI 1659322642
  NPD (past)

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

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597622400000",
    "number": "1154696359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11937 US HIGHWAY 271",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757083154",
            "telephone_number": "903-877-7168",
            "fax_number": "903-877-8355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11937 US HIGHWAY 271",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757083154",
            "telephone_number": "903-877-7168",
            "fax_number": "903-877-8355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 E Chestnut St",
            "address_2": "2nd Floor",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402021831",
            "country_code": "US",
            "telephone_number": "502-588-0809",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Executive Park # 103",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "40207",
            "country_code": "US",
            "telephone_number": "502-313-6877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TIYA",
        "middle_name": "SHALYSE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-20",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "FL",
            "license": "ME129560",
            "primary": false
        },
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "OH",
            "license": "130324",
            "primary": false
        },
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "KY",
            "license": "48143",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "130324",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KY",
            "license": "48143",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME129560",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "OH",
            "license": "130324",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME129560",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "KY",
            "license": "48143",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "S7462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Inge Johnson, M.D.
• Pegan Danielle Johnson, M.S., CCC-SLP
• Roel Mario Johnson, APT
• Shearren Johnson
• Tiffany Johnson
• Charles Michael Johnston, PT
• Douglas Frederick Johnston, DO
• Keelie Johnston, PA-C
• Tori Johnston, FNP-C
• Joint Recovery Services LLC

• Child & Adolescent Psychiatry Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Child & Adolescent Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.