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NPI Code Detail

MEDICARE: DR. JASON CHURCHWELL PHD

MEDICARE: DR. JASON CHURCHWELL PHD
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
1103TC0700XClinical PsychologistPSY23563CA
2103TF0200XForensic Psychologist

General Provider Information

NPI Number : 1609909068
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON CHURCHWELL PHD
Provider Business Mailing Address
First Line : 14901 CENTRAL AVE
Second Line :
City : CHINO
State : CA
Zip : 91710-9500
Country : US
Telephone Number : 909-597-1821
Fax Number :
Provider Business Practice Location Address
First Line : 14901 CENTRAL AVE
Second Line :
City : CHINO
State : CA
Zip : 91710-9500
Country : US
Telephone Number : 909-597-1821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 01/23/2015

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