Active NPI
Tyson Davis
- Clinical Psychologist
- Austin, TX
National Provider Identifier
1417205774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS017720
- Practice address
- 1515 S Capital of Texas Hwy
Ste 200
Austin, TX 78746-6544 - Phone
- (512) 767-1136
- NPI assigned
- Aug 16, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 38201 | TX | |
| Clinical Psychologist | 103TC0700X | PS017720 | PA | Primary |
Addresses
Primary practice location
1515 S Capital of Texas Hwy
Ste 200
Austin, TX 78746-6544
Mailing address
1515 S Capital of Texas Hwy
Ste 200
Austin, TX 78746-6544
Phone (512) 767-1136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2025 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Psychological Associates | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Neuropsychologist
- Allentown, PA
- NPI 1336100387
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581984000000",
"number": "1417205774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 S CAPITAL OF TEXAS HWY",
"address_2": "STE 200",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787466544",
"telephone_number": "512-767-1136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 S CAPITAL OF TEXAS HWY",
"address_2": "STE 200",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787466544",
"telephone_number": "512-767-1136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "TYSON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-16",
"last_updated": "2020-02-18",
"certification_date": "2020-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "38201",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS017720",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.