Joseph Edward Black, PH.D.
Individual provider Active NPI Counseling Psychologist · Jackson, OH
NPI 1124178918 · NPPES record last updated Nov 22, 2011
Key facts
- NPI
- 1124178918
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counseling Psychologist 103TC1900X
- License
- 4889 (OH)
- Practice address
- 731 E Main St
Suite 13
Jackson, OH 45640-2100 - Phone
- (740) 286-8789
- Fax
- (740) 286-8789
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4889 | OH | MD | Counseling Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 4889 | OH | Yes |
Addresses
Primary practice location
731 E Main St
Suite 13
Jackson, OH 45640-2100
Mailing address
1328 Cremeens Rd
Patriot, OH 45658-9319
Phone (740) 256-6442
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2047529 | Medicaid | OH |
Other names
- J. Edward Black
Other providers in Jackson, OH
- Tiffany Renee Benner
- Jamie L Bennett
- Richard Harris Billman II
- Bio-Medical Applications of Ohio Inc
- Stephanie Ruth Bixler
- Micah Nicole Blankenship
- Natosha D Blanton
- Lori Bock
- Jessica Boggs
- Lora Jean Boggs
All providers in Jackson, OH · Counseling Psychologist in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.