Healthcare Provider Details

I. General information

NPI: 1356508295
Provider Name (Legal Business Name): JARED LYON SKILLINGS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15019 BANKFIELD DR
WATERFORD VA
20197-1265
US

IV. Provider business mailing address

15019 BANKFIELD DR
WATERFORD VA
20197-1265
US

V. Phone/Fax

Practice location:
  • Phone: 616-648-4084
  • Fax:
Mailing address:
  • Phone: 616-648-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810008181
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0810008181
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810008181
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number0810008181
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number0810008181
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013341
License Number StateMI
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008181
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number0810008181
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6301013341
License Number StateMI
# 10
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301013341
License Number StateMI
# 11
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number0810008181
License Number StateVA
# 12
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6301013341
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: