Individual provider Active NPI

Jeremy T. Walden, PSY.D.

  • Counseling Psychologist
  • Midlothian, VA
National Provider Identifier
1649535246
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
Practice address
312 Browns Hill CT
Midlothian, VA 23114-9511
Phone
(804) 893-5555
Fax
(804) 893-5553
NPI assigned
Jul 10, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X Primary

Addresses

Primary practice location

312 Browns Hill CT
Midlothian, VA 23114-9511

Mailing address

312 Browns Hill CT
Midlothian, VA 23114-9511
Phone (804) 893-5555

Other practice location 1

9568 Kings Charter Dr Ste 101
Ashland, VA 23005-7955
Phone (804) 893-5555

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20141201001474 VA Practitioner - Clinical Psychologist 0042532194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dougan and Walden Wellness PLLCGroup PAC ID 7012345267, 9 clinicians

Practice addresses (Care Compare)

312 Browns Hill CT
Midlothian, VA 23114-9511
Phone (804) 893-5555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0810004838VAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dougan and Walden Wellness, PLLC CurrentSince Jun 30, 2017 Accepting new patients

Locations

9568 Kings Charter Dr
Ashland, VA 23005

9568 Kings Charter Dr
Ste 101
Ashland, VA 23005
Phone (804) 496-6559

312 Browns Hill Ct
Midlothian, VA 23114
Phone (804) 651-1830

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1649535246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 BROWNS HILL CT",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231149511",
            "telephone_number": "804-893-5555",
            "fax_number": "804-893-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 BROWNS HILL CT",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231149511",
            "telephone_number": "804-893-5555",
            "fax_number": "804-893-5553"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9568 Kings Charter Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Ashland",
            "state": "VA",
            "postal_code": "230057955",
            "country_code": "US",
            "telephone_number": "804-893-5555",
            "fax_number": "804-893-5553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALDEN",
        "first_name": "JEREMY",
        "middle_name": "T.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-10",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midlothian, VA

Sources for this page

Verify at the official NPI Registry.