NPIMap

Organization Active NPI

Battle-Born Psychological Services, LLC

  • Clinical Psychologist
  • North Las Vegas, NV
National Provider Identifier
1912377482
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
BATTLE-BORN PSYCHOLOGICAL SERVICES, LLC
Practice address
5836 Beluga Bay St
North Las Vegas, NV 89081-6843
Phone
(702) 941-0583
Fax
(702) 518-0966
NPI assigned
Sep 28, 2015
Last updated
Apr 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Authorized official

Name
Dr. Earnest Howard-Rudolph Blackshear, PHDNPI 1386883932
Title
Ceo & Primary Consultant
Phone
(702) 941-0583

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

5836 Beluga Bay St
North Las Vegas, NV 89081-6843

Mailing address

5836 Beluga Bay St
North Las Vegas, NV 89081-6843
Phone (702) 941-0583

Other names 1

  • Black-Belt Psychological Services Former legal business name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address Battle-Born.Psych.Svcs@outlook.com Health Information Exchange (HIE)
Direct Messaging Address Battle-Born.Psych.Svcs@outlook.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1912377482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5836 BELUGA BAY ST",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890816843",
            "telephone_number": "702-941-0583",
            "fax_number": "702-518-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5836 BELUGA BAY ST",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890816843",
            "telephone_number": "702-941-0583",
            "fax_number": "702-518-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BATTLE-BORN PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-28",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "BLACKSHEAR",
        "authorized_official_first_name": "EARNEST",
        "authorized_official_middle_name": "HOWARD-RUDOLPH",
        "authorized_official_title_or_position": "CEO & PRIMARY CONSULTANT",
        "authorized_official_telephone_number": "702-941-0583",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Battle-Born.Psych.Svcs@outlook.com",
            "affiliation": "N",
            "endpointDescription": "End to end  S/MIME encryption for data in transit and BitLocker is used  for  data at rest.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5836 Beluga Bay St",
            "city": "North Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "890816843",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Battle-Born.Psych.Svcs@outlook.com",
            "affiliation": "N",
            "endpointDescription": "End to end encryption",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5836 Beluga Bay St",
            "city": "North Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "890816843",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Black-Belt Psychological Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in North Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.