Blank Psychological Services, Inc.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

BLANK PSYCHOLOGICAL SERVICES, INC.

Practice address

27403 Ynez Rd Ste 205
Temecula, CA 92591-4616

Phone

(951) 595-7386

Fax

(951) 414-3770

NPI assigned

Dec 18, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Jeremy Blank, PSYDNPI 1215260591

Title

President

Phone

(951) 595-7386

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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

• Jeremy Blank, PSY.D.

  • Clinical Neuropsychologist
  • Temecula, CA
  • NPI 1215260591
  Medicare reassignment NPD Authorized official
• Sylvia Hemly Samy, LCSW

  • Professional Counselor
  • Temecula, CA
  • NPI 1275975245
  NPD

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1487422747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27403 YNEZ RD STE 205",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925914616",
            "telephone_number": "951-595-7386",
            "fax_number": "951-414-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27403 YNEZ RD STE 205",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925914616",
            "telephone_number": "951-595-7386",
            "fax_number": "951-414-3770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLANK PSYCHOLOGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-18",
        "last_updated": "2024-01-04",
        "certification_date": "2023-12-19",
        "status": "A",
        "authorized_official_last_name": "BLANK",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-595-7386",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parikshit Bittla
• Karen G Black, LMFT
• Van Allen Black Jr.
• Katherine Marie Maclay Blackwell, LMFT
• Stephanie Blair, BCBA
• Emily Blank
• Jeremy Blank, PSY.D.
• Hannah Bledsoe, RBT
• Jessica Marie-Pedroza Blevins, LMFT, ATR
• Brooke Lorraine Blomberg

• Adult Mental Health Clinic/Center in Temecula, CA
• Providers in Temecula, CA by specialty
• Adult Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; 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.