Active NPI
Jeffrey Bruce Elliott, PSYD
- Clinical Psychologist
- San Luis Obispo, CA
National Provider Identifier
1114919263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 17917
- Practice address
- 2178 Johnson Ave
San Luis Obispo, CA 93401-4535 - Phone
- (805) 781-5525
- Fax
- (805) 781-1232
- NPI assigned
- Aug 16, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 17917 | CA | Primary |
Addresses
Primary practice location
2178 Johnson Ave
San Luis Obispo, CA 93401-4535
Mailing address
PO Box 425
Santa Maria, CA 93456-0425
Phone (805) 934-5900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 17917 | CA | MD | Clinical Psychologist |
| 17917 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114919263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 425",
"city": "SANTA MARIA",
"state": "CA",
"postal_code": "934560425",
"telephone_number": "805-934-5900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2178 JOHNSON AVE",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934014535",
"telephone_number": "805-781-5525",
"fax_number": "805-781-1232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "JEFFREY",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 17917",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
- Elite Eyecare Medical Group a Medical Corporation (Shepard Eye Center)
- Elite Eyecare Medical Group a Medical Corporation (SLO Laski and Cataract)
- Bailey M Elkins
- Dawn L Ellerson, M.D.
- Jeffery D Elliott, NP
- Teri L. Elliott, LMFT
- Donald Alan Ellis, D.D.S.
- Tamara Ellstrom, LVN
- Douglas Gregory Elterman
- Janet Kay Emmons, M.F.T.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.