Jack Teeple, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

710 Issued in KY

Practice address

455 S 4TH St Ste 842
Louisville, KY 40202-2576

Phone

(502) 584-7216

Fax

(502) 585-5373

NPI assigned

Aug 29, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Enrolled in KY

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, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699884387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 S 4TH ST STE 842",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022576",
            "telephone_number": "502-584-7216",
            "fax_number": "502-585-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 S 4TH ST STE 842",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022576",
            "telephone_number": "502-584-7216",
            "fax_number": "502-585-5373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEEPLE",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89007108",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Molly Ann Halpin Techau, LPCC, LMFT
• Brenna Teegarden
• Michala Tyann Teelucksingh
• Teen Pregnancy Prevention Intervention (Center for Adolescent Pregnancy Prevention)
• Teen Pregnancy Prevention Intervention Inc (Center for Adolescent Pregnancy Prevention)
• Sarah Elizabeth Teeple, CERT. HEALTH COACH
• Mistie Rachelle Teer, APRN
• Jasmine Tifarah Teeters
• Rahel A Teferra, M.D.
• Tessa Tegarden, PTA

• Clinical Psychologist in Louisville, KY
• Providers in Louisville, KY by specialty
• Clinical Psychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.