MEDICARE: DR. JERROLD YEO JUN TIAN 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	103TC0700X	Clinical Psychologist	PS018915	PA
2	103TR0400X	Rehabilitation Psychologist
3	103G00000X	Clinical Neuropsychologist
4	103T00000X	Psychologist	PS018915	PA

General Provider Information

NPI Number	:	1851638050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERROLD YEO JUN TIAN PSYD

Provider Business Mailing Address
First Line	:	1312 17TH ST STE 77888
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1508
Country	:	US
Telephone Number	:	878-227-9736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 17TH ST STE 77888
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1508
Country	:	US
Telephone Number	:	878-227-9736
Fax Number	:	855-336-7188

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

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	11/05/2025

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