Tyler Maxwell Dority, PHD, LP
NPI 1104394212ActiveIndividual· Psychologist, Clinical· Mankato, MN
Psychologist, Clinical (PHD, LP) in Mankato, Minnesota, licensed in MN, with an NPI issued in November 2018. Medicare paid $20,196 for services to 31 patients in 2024.
Overview
| NPI | 1104394212 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PHD, LP |
| Sole proprietor | Yes |
| NPI issued | Nov 6, 2018 |
| Last updated in NPPES | Aug 2, 2022 |
| Certified by provider | Aug 2, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | LP6328 | MN |
| Psychologist, Counseling | 103TC1900X | LP6328 | MN |
| Psychologist, Forensic | 103TF0200X | LP6328 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Psychologist (MN) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 31 |
|---|---|
| Services billed | 274 across 7 procedure codes |
| Paid by Medicare | $20,196 |
Education and affiliations
| Graduation year | 2016 |
|---|---|
| Medicare specialty | Clinical Psychologist |
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All 25 clinical psychologists in Mankato · All clinical psychologists in Minnesota