NPIMap

Organization Active NPI

Bayside Psychology Services, LLC

  • Clinical Psychologist
  • Niceville, FL
National Provider Identifier
1922388909
Registry record updated Aug 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
5264 Issued in FL
Legal business name
BAYSIDE PSYCHOLOGY SERVICES, LLC
Practice address
4400 E Highway 20
Ste 305
Niceville, FL 32578-8779
Phone
(850) 279-6750
Fax
(850) 279-6752
NPI assigned
Aug 23, 2011
Last updated
Aug 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2011

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

Authorized official

Name
Dr. Gretchen Chapman Tyler, PH.D.
Title
Licensed Psychologist / President
Phone
(850) 279-6750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 5264 FL Primary

Addresses

Primary practice location

4400 E Highway 20
Ste 305
Niceville, FL 32578-8779

Mailing address

4400 E Highway 20
Ste 305
Niceville, FL 32578-8779
Phone (850) 279-6750

National Provider Directory

National Provider Directory

Locations

1417 Partin Dr N
Niceville, FL 32578
Phone (850) 729-0303

4400 E Highway 20
Ste 305
Niceville, FL 32578
Phone (850) 279-6750

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1314057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314057600000",
    "number": "1922388909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 E HIGHWAY 20",
            "address_2": "STE 305",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788779",
            "telephone_number": "850-279-6750",
            "fax_number": "850-279-6752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 E HIGHWAY 20",
            "address_2": "STE 305",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788779",
            "telephone_number": "850-279-6750",
            "fax_number": "850-279-6752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSIDE PSYCHOLOGY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-23",
        "last_updated": "2011-08-23",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_middle_name": "CHAPMAN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST / PRESIDENT",
        "authorized_official_telephone_number": "850-279-6750",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "5264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; 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.