Jack Jaffe, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

31536 Issued in TX

Practice address

6330 Lyndon B Johnson Fwy Ste 130
Dallas, TX 75240-6443

Phone

(972) 693-5485

NPI assigned

Aug 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

In Luck Counseling LLCGroup PAC ID 4880030667, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• In Luck Counseling LLC

  dba Natalia Lueck LPC

  • Mental Health Counselor
  • Warrenton, VA
  • NPI 1174181168
  Medicare reassignment Care Compare group NPD
• Two Rivers Wellness Center LLC

  • Mental Health Counselor
  • Williamsburg, VA
  • NPI 1356971022
  Medicare reassignment NPD
• Jack Jaffe

  dba Jaffe Psychological Services

  • Clinical Psychologist
  • Dallas, TX
  • NPI 1508620766
  NPD Authorized official
• Jaffe Psychological Services LLC

  • Psychologist
  • Warrenton, VA
  • NPI 1942175831
  NPD Authorized official

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1144334269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7422 FOXWORTH DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752483038",
            "telephone_number": "972-693-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6330 LYNDON B JOHNSON FWY STE 130",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752406443",
            "telephone_number": "972-693-5485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAFFE",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "31536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149708301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "86707A",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Noggy David Jaen, FNP
• Brian Jafari
• Carley Jafari, BCBA
• Michael Jafarzadeh, PSYD
• Asra Jaffar
• Samantha Hope Jaffe, M.A., LMFT
• Jay Bennett Jaffee, M.D.
• Syeda Uzma Jaffery, M.D.
• Waseem Muhammad Jaffrani, M.D
• Bintay Jafri, MD

• Clinical Psychologist in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.