=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427331024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES MADISON UNIVERSITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2011
-----------------------------------------------------
Last Update Date | 11/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | JAMES MADISON UNIVERSITY 601 UNIVERSITY BLVD.
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22807-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-568-8829
-----------------------------------------------------
Fax | 540-568-7988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | JAMES MADISON UNIVERSITY ALDC MSC 9013
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22807-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-568-8829
-----------------------------------------------------
Fax | 540-568-7988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF JMU ALDC
-----------------------------------------------------
Name | TREVOR STOKES
-----------------------------------------------------
Credential | PHD.
-----------------------------------------------------
Telephone | 540-568-8829
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 0810004387
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------