Amelia Black, PH.D., CGP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY0928 Issued in NV

Practice address

Ceb 226 4505 S. Maryland Pkwy
Box #453033
Las Vegas, NV 89154

Phone

(702) 895-1532

NPI assigned

Jul 29, 2020

Last updated

Aug 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Previously, effective Sep 15, 2020 through Sep 15, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Caryatid Cooperative for Nevada

  dba The Evidence Based Practice of Nevada

  • Psychologist
  • Las Vegas, NV
  • NPI 1760046411
  NPD (past)

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

{
    "created_epoch": "1595980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1770192379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CEB 226 4505 S. MARYLAND PKWY",
            "address_2": "BOX #453033",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89154",
            "telephone_number": "702-895-1532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CEB 226 4505 S. MARYLAND PKWY",
            "address_2": "BOX #453033",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89154",
            "telephone_number": "702-895-1532"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2460 Paseo Verde Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890747136",
            "country_code": "US",
            "telephone_number": "702-508-9181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "AMELIA",
        "name_prefix": "Dr.",
        "credential": "PH.D., CGP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-29",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NV",
            "license": "PY0928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Filip Bjelica
• Josh Bjork
• Brandi Nicole Bjornstad, APRN-CNP
• Viviana Orozco Black (Rojas), LMFT-I, LCADC-I
• Shalina Jo Black-Bennett
• Aries Black
• Ashshana Black
• Chad Robinson Black, MD
• Charlette Black
• Colbie Black

• Psychologist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Psychologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; 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.

Verify at the official NPI Registry.