Individual
DR. MARY DOLORES TYLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD ABPP MSCP
Contact information
Practice address
509 MARR ST, TRUTH OR CONSEQUENCES, NM 87901-3335
(915) 929-9362
Mailing address
509 MARR ST, TRUTH OR CONSEQUENCES, NM 87901-3335
(915) 929-9362
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
1310
NM
103TC0700X
Clinical Psychologist
Primary
PY 6142
FL
103TP0016X
Prescribing (Medical) Psychologist
PSY-RXP0061
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1310
NM BOARD OF PSYCHOLOGIST EXAMINERS-PSYCHOLOGY
NM
01
—
PSY-RXP0061
PRESCRIBING PSYCHOLOGIST
NM
01
—
PY6142
FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE-PSYCHOLOGY
FL
Enumeration date
01/05/2007
Last updated
04/17/2025
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