Individual provider Active NPI

Mallory Sims Tyre, LMFT

  • Marriage & Family Therapist
  • Valdosta, GA
National Provider Identifier
1679089320
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFT001575 Issued in GA
Practice address
3120 N Oak Street Ext Ste B
Valdosta, GA 31602-5910
Phone
(229) 671-6170
NPI assigned
Dec 18, 2017
Last updated
Mar 9, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFT001575 GA Primary

Addresses

Primary practice location

3120 N Oak Street Ext Ste B
Valdosta, GA 31602-5910

Mailing address

3120 N Oak Street Ext Ste B
Valdosta, GA 31602-5910
Phone (229) 671-6170

Other identifiers 1

IdentifierTypeStateIssuer
MFT001575OtherGALICENSED MARRIAGE AND FAMILY THERAPIST

Other names 1

  • Mallory Marie Sims Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240110002243 GA Practitioner - Marriage and Family Therapist 5597116970 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Health Services of South Georgia CurrentSince Jan 1, 2024 Accepting new patients
Behavioral Health Crisis Center Past Accepting new patients

Locations

203 Industrial Park Dr
Adel, GA 31620
Phone (229) 896-4559

334 Tifton Eldorado Rd
Tifton, GA 31794
Phone (229) 391-2300

3120 N Oak Street Ext
Ste B
Valdosta, GA 31602
Phone (229) 671-6164

3120 N Oak Street Ext
Ste C
Valdosta, GA 31602
Phone (229) 671-6100

Organizations & group practices 2

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": "1513555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773014400000",
    "number": "1679089320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 N OAK STREET EXT STE B",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316025910",
            "telephone_number": "229-671-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 N OAK STREET EXT STE B",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316025910",
            "telephone_number": "229-671-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYRE",
        "first_name": "MALLORY",
        "middle_name": "SIMS",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-18",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT001575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED MARRIAGE AND FAMILY THERAPIST",
            "identifier": "MFT001575",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "SIMS",
            "middle_name": "MARIE",
            "credential": "LMFT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.