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ANTANISSHA TYLER
NPI 1154994879
Marriage & Family Therapist in Redondo Beach, CA

Active since July 20, 2021PECOS Enrolled
1200 AVIATION BLVD, REDONDO BEACH, CA 90278(310) 376-2468 Get Directions Write a Review

NPPES record last updated: July 20, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Antanissha Tyler NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANTANISSHA TYLER (NPI 1154994879) is an individual marriage & family therapist in Redondo Beach, California, licensed in California (117223) and active in the NPI registry since July 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1154994879
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameANTANISSHA TYLER
Location Address1200 AVIATION BLVDRedondo Beach, CA 90278-4064
Mailing AddressPo Box 59612Los Angeles, CA 90059-0612 · (323) 350-4291
Phone(310) 376-2468
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateJuly 20, 2021
NPPES CertifiedJuly 20, 2021
✔ NPI 1154994879 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · 117223
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
1200 AVIATION BLVD, Redondo Beach, CA 90278
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Antanissha Tyler is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7315416575
PECOS Enrollment IDI20260516000407
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Antanissha Tyler reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Sud Specialty Group - Ca
316 mi
Addiction Medicine
4633 OLD IRONSIDES DR STE 304
Santa Clara, CA 95054
  • Reassigned Medicare billing, California enrollment
  • 1,607 clinicians in this Medicare group
NPI 1972138238 (323) 205-7088

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MELISSA MARIE RAINES RBT
Behavior Technician
1200 AVIATION BLVD
REDONDO BEACH, CA 90278
Los Angeles County (310) 376-2468
MRS. JOHANNA L SCHATZ P.T.
Physical Therapist
1200 AVIATION BLVD, SUITE 101
REDONDO BEACH, CA 90278
Los Angeles County (310) 374-6363
JORDAN SILVERMAN
Behavior Technician
1200 AVIATION BLVD
REDONDO BEACH, CA 90278
Los Angeles County (310) 266-5109
MS. LISA RAMOS LMFT
Marriage & Family Therapist
1200 AVIATION BLVD
REDONDO BEACH, CA 90278
Los Angeles County (310) 376-2468
NELSON CHIROPRACTIC CORPORATION
Chiropractor
1200 AVIATION BLVD, 101
REDONDO BEACH, CA 90278
Los Angeles County (310) 374-6363
DR. DAVID GUNNER MURO D.C.
Chiropractor
1200 AVIATION BLVD, SUITE 101
REDONDO BEACH, CA 90278
Los Angeles County (310) 374-6363

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Antanissha Tyler's NPI number?

The NPI number for Antanissha Tyler is 1154994879. It was assigned to this individual provider in the NPPES registry on July 20, 2021.

Where is Antanissha Tyler located?

Antanissha Tyler practices at 1200 Aviation Blvd, Redondo Beach, CA 90278. The listed phone number is (310) 376-2468.

What is Antanissha Tyler's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Antanissha Tyler enrolled in Medicare?

Yes. Antanissha Tyler is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Antanissha Tyler's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Antanissha Tyler reassigns Medicare benefits to Sud Specialty Group - Ca (Santa Clara, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Antanissha Tyler's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Antanissha Tyler was last updated on July 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.