Active NPI
Mary Dolores Tyll, PHD ABPP MSCP
- Clinical Psychologist
- Truth Or Consequences, NM
National Provider Identifier
1356498919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY 6142
- Practice address
- 509 Marr St
Truth Or Consequences, NM 87901-3335 - Phone
- (915) 929-9362
- NPI assigned
- Jan 5, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1310 | NM | |
| Prescribing (Medical) Psychologist | 103TP0016X | PSY-RXP0061 | NM | |
| Clinical Psychologist | 103TC0700X | PY 6142 | FL | Primary |
Addresses
Primary practice location
509 Marr St
Truth Or Consequences, NM 87901-3335
Mailing address
509 Marr St
Truth Or Consequences, NM 87901-3335
Phone (915) 929-9362
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY-RXP0061 | Other | NM | PRESCRIBING PSYCHOLOGIST |
| 1310 | Other | NM | NM BOARD OF PSYCHOLOGIST EXAMINERS-PSYCHOLOGY |
| PY6142 | Other | FL | FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE-PSYCHOLOGY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 6142 | FL | MD | Clinical Psychologist |
| PSY-RXP0061 | NM | MD | Prescribing (Medical) Psychologist |
| 1310 | NM | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744848000000",
"number": "1356498919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "509 MARR ST",
"city": "TRUTH OR CONSEQUENCES",
"state": "NM",
"postal_code": "879013335",
"telephone_number": "915-929-9362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "509 MARR ST",
"city": "TRUTH OR CONSEQUENCES",
"state": "NM",
"postal_code": "879013335",
"telephone_number": "915-929-9362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYLL",
"first_name": "MARY",
"middle_name": "DOLORES",
"name_prefix": "Dr.",
"credential": "PHD ABPP MSCP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2025-04-17",
"certification_date": "2025-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NM",
"license": "1310",
"primary": false
},
{
"code": "103TP0016X",
"taxonomy_group": "",
"desc": "Psychologist, Prescribing (Medical)",
"state": "NM",
"license": "PSY-RXP0061",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY 6142",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRESCRIBING PSYCHOLOGIST",
"identifier": "PSY-RXP0061",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NM BOARD OF PSYCHOLOGIST EXAMINERS-PSYCHOLOGY",
"identifier": "1310",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE-PSYCHOLOGY",
"identifier": "PY6142",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Truth Or Consequences, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.