MEDICARE: JP PSYCHOLOGICAL SERVICES LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1841883311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JP PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	10731 MORNING FROST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89179-1301
Country	:	US
Telephone Number	:	702-758-4089
Fax Number	:

Provider Business Practice Location Address
First Line	:	10731 MORNING FROST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89179-1301
Country	:	US
Telephone Number	:	702-758-4089
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERICA PHILLIPS
Credential	:	PSYD
Telephone Number	:	702-758-4089

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	02/16/2021

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