Active NPI
Tyresha Lyna Wallace
- Doula
- Great Mills, MD
National Provider Identifier
1497568455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Doula
- Practice address
- 45528 Coosan CT
Great Mills, MD 20634-2454 - Phone
- (443) 404-9473
- NPI assigned
- Jan 31, 2025
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Doula | 374J00000X | MD | Primary |
Addresses
Primary practice location
45528 Coosan CT
Great Mills, MD 20634-2454
Mailing address
1517 Reisterstown Rd
Pikesville, MD 21208-4325
Phone (410) 541-1316
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| All Star ABA LLC | Behavior Technician | Current | Accepting new patients |
Locations
1517 Reisterstown Rd
Pikesville, MD 21208
Phone (410) 541-1316
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781481600000",
"number": "1497568455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1517 REISTERSTOWN RD",
"city": "PIKESVILLE",
"state": "MD",
"postal_code": "212084325",
"telephone_number": "410-541-1316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45528 COOSAN CT",
"city": "GREAT MILLS",
"state": "MD",
"postal_code": "206342454",
"telephone_number": "443-404-9473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "TYRESHA",
"middle_name": "LYNA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-01-31",
"last_updated": "2026-06-15",
"certification_date": "2026-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "374J00000X",
"taxonomy_group": "",
"desc": "Doula",
"state": "MD",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Mills, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.