Emerald Psychological Services, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

EMERALD PSYCHOLOGICAL SERVICES, LLC

Practice address

5032 S Bur Oak PL
Ste. 120
Sioux Falls, SD 57108-2243

Phone

(605) 362-2617

Fax

(605) 362-2654

NPI assigned

Oct 17, 2014

Last updated

Oct 17, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeremy L Johnson, PHD

Title

Owner/Psychologist

Phone

(605) 362-2617

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413504000000",
    "number": "1346644432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5032 S BUR OAK PL",
            "address_2": "STE. 120",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082243",
            "telephone_number": "605-362-2617",
            "fax_number": "605-362-2654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5032 S BUR OAK PL",
            "address_2": "STE. 120",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082243",
            "telephone_number": "605-362-2617",
            "fax_number": "605-362-2654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-17",
        "last_updated": "2014-10-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "605-362-2617",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "SD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.