Active NPI
Madalyn E. Tyson, PH.D.
- Psychologist
- Charlotte, NC
National Provider Identifier
1639138639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1131
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 1131 | NC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Ridge Behavior Systems Inc | Psychologist | 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.
-
- Psychologist
- Charlotte, NC
- NPI 1720698939
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.