Colby Michael Tyson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CTB2024668 Issued in NM

Practice address

5201 Venice Ave NE Ste a
Albuquerque, NM 87113-2337

Phone

(505) 796-6367

NPI assigned

Dec 2, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Mandala Integrated Therapy LLC

  • Community/Behavioral Health Agency
  • Albuquerque, NM
  • NPI 1225763568
  NPD

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

{
    "created_epoch": "1512172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1770098543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6416 TAUTON RD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871202040",
            "telephone_number": "505-918-2901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 VENICE AVE NE STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132337",
            "telephone_number": "505-796-6367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSON",
        "first_name": "COLBY",
        "middle_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-02",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CTB2024668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Tyler
• Talia Tyler
• Kathryn Canfield Tyndall, OTR
• Ryan P. Tyner, M.D.
• Tristan Chere Tysdal
• Dilshani N Tyson, LMHC
• Antonios Tzamaloukas, MD
• Erasicleia Tzamaloukas, CNS
• Loryn Victoria Udell, FNP-BC
• Rio Udell, PA-C

• Mental Health Counselor in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.