Active NPI
Jennifer Lynn McCollum, PH.D.
- Clinical Psychologist
- Menlo Park, CA
National Provider Identifier
1710296322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY23758
- Practice address
- 885 Oak Grove Ave
Suite 102-1
Menlo Park, CA 94025-4433 - Phone
- (650) 427-9105
- NPI assigned
- Sep 29, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY23758 | CA | Primary |
Addresses
Primary practice location
885 Oak Grove Ave
Suite 102-1
Menlo Park, CA 94025-4433
Mailing address
3755 Sundale Rd
Lafayette, CA 94549-3503
Phone (650) 427-9105
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 16, 2021 through Sep 16, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY23758 | CA | MD | Clinical Psychologist |
| 23758 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285718400000",
"number": "1710296322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3755 SUNDALE RD",
"city": "LAFAYETTE",
"state": "CA",
"postal_code": "945493503",
"telephone_number": "650-427-9105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "885 OAK GROVE AVE",
"address_2": "SUITE 102-1",
"city": "MENLO PARK",
"state": "CA",
"postal_code": "940254433",
"telephone_number": "650-427-9105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCOLLUM",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-29",
"last_updated": "2010-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY23758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menlo Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.