MEDICARE: TYRELL KING PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	40076	TX

General Provider Information

NPI Number	:	1114870060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRELL KING PSYD

Provider Business Mailing Address
First Line	:	11906 UPLANDS RIDGE DR
Second Line	:
City	:	BEE CAVE
State	:	TX
Zip	:	78738-5007
Country	:	US
Telephone Number	:	512-466-8237
Fax Number	:

Provider Business Practice Location Address
First Line	:	11701 BEE CAVES RD STE 207
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78738-6468
Country	:	US
Telephone Number	:	512-261-8273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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