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General NPI Number Information
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NPI Number | 1740528702
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Entity Type | Organization
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Legal Business Name | VAJRA PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 01/26/2013
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Last Update Date | 02/08/2013
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Provider Practice Location Address
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Address Line | 753 N STATE ST SUITE J
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City | NORTH VERNON
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State | IN
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Zip | 47265-1044
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Country | US
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Telephone | 812-346-7744
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Fax | 812-346-3815
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Provider Business Mailing Address
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Address Line | 753 N STATE ST SUITE J
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City | NORTH VERNON
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State | IN
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Zip | 47265-1044
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Country | US
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Telephone | 812-346-7744
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Fax | 812-346-3815
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON HOLLAND
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Credential | PHD
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Telephone | 812-498-3470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20042015A
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License Number State | IN
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