Healthcare Provider Details

I. General information

NPI: 1528329018
Provider Name (Legal Business Name): MAYER M JEPPSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MDG/RAF LAKENHEATH UNIT 5115
APO AE
09461-5115
US

IV. Provider business mailing address

48 MDG/RAF LAKENHEATH UNIT 5115
APO AE
09461-5115
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8603
  • Fax:
Mailing address:
  • Phone: 314-226-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8074186-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: