NPIMap

Organization Active NPI

Victory Psych Consultation Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Blackwood, NJ
National Provider Identifier
1124781364
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
VICTORY PSYCH CONSULTATION SERVICES
Practice address
188 Fries Mill Rd Ste E2
Blackwood, NJ 08012-2015
Phone
(551) 214-4475
Fax
(609) 237-0772
NPI assigned
Oct 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Yahaya A Animashaun, APNNPI 1710157961
Title
Nurse Practioner
Phone
(908) 247-8768

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

188 Fries Mill Rd Ste E2
Blackwood, NJ 08012-2015

Mailing address

188 Fries Mill Rd Ste E2
Blackwood, NJ 08012-2015
Phone (551) 214-4475

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL SOAPURL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211027002741 NJ Part B Supplier - Clinic/Group Practice 7214325000 Receives reassigned benefits from 6 practitioners
Practice locations: Blackwood, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784678400000",
    "number": "1124781364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 FRIES MILL RD STE E2",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080122015",
            "telephone_number": "551-214-4475",
            "fax_number": "609-237-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 FRIES MILL RD STE E2",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080122015",
            "telephone_number": "551-214-4475",
            "fax_number": "609-237-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY PSYCH CONSULTATION SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-14",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A",
        "authorized_official_last_name": "ANIMASHAUN",
        "authorized_official_first_name": "YAHAYA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "NURSE PRACTIONER",
        "authorized_official_telephone_number": "908-247-8768",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "SOAPURL",
            "affiliation": "N",
            "endpointDescription": "SOAPURL",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10 Eton Dr",
            "city": "Sewell",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080802482",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Blackwood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.