Individual provider Active NPI

Madalyn E. Tyson, PH.D.

  • Psychologist
  • Charlotte, NC
National Provider Identifier
1639138639
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1131 Issued in NC
Practice address
16426 Hawfield Woods LN
Charlotte, NC 28277-6108
Phone
(704) 540-4291
Fax
(704) 541-0319
NPI assigned
Mar 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X 1131 NC
Clinical Child & Adolescent Psychologist 103TC2200X 1131 NC
Psychologist 103T00000X 1131 NC Primary
Intellectual & Developmental Disabilities Psychologist 103TM1800X 1131 NC

Addresses

Primary practice location

16426 Hawfield Woods LN
Charlotte, NC 28277-6108

Mailing address

16426 Hawfield Woods LN
Charlotte, NC 28277-6108
Phone (704) 540-4291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Previously, effective Aug 28, 2014 through Aug 28, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1131NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Behavior Systems Inc Psychologist PastSince Aug 9, 2020 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.

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1639138639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16426 HAWFIELD WOODS LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776108",
            "telephone_number": "704-540-4291",
            "fax_number": "704-541-0319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16426 HAWFIELD WOODS LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776108",
            "telephone_number": "704-540-4291",
            "fax_number": "704-541-0319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSON",
        "first_name": "MADALYN",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-20",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NC",
            "license": "1131",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NC",
            "license": "1131",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "1131",
            "primary": true
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "NC",
            "license": "1131",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.