Peoria Psychological Associates, P.C.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071005320 Issued in IL

Legal business name

PEORIA PSYCHOLOGICAL ASSOCIATES, P.C.

Practice address

5505 N Fairmont Dr
Peoria, IL 61614-4246

Phone

(309) 689-6700

Fax

(309) 689-0774

NPI assigned

Feb 9, 2006

Last updated

Apr 12, 2012By 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. Jane Velez, PSY.D.NPI 1699781260

Title

Owner, Clinical Psychologist

Phone

(309) 689-6700

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jane Velez, PSY.D.

  • Clinical Psychologist
  • Peoria, IL
  • NPI 1699781260
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334188800000",
    "number": "1427021393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5505 N FAIRMONT DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144246",
            "telephone_number": "309-689-6700",
            "fax_number": "309-689-0774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 N FAIRMONT DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144246",
            "telephone_number": "309-689-6700",
            "fax_number": "309-689-0774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA PSYCHOLOGICAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-09",
        "last_updated": "2012-04-12",
        "status": "A",
        "authorized_official_last_name": "VELEZ",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "OWNER, CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "309-689-6700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005320",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "IL",
            "license": "14987",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Peoria, IL
• Providers in Peoria, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; 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.