Ricky Lee Jentons, MALLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301005971 Issued in MI

Practice address

18181 Oakwood Blvd
311
Dearborn, MI 48124-5032

Phone

(313) 271-8170

Fax

(313) 271-8353

NPI assigned

Oct 15, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Victor M. Cruz MD, P.C.

  dba Cruz Clinic

  • Psychiatry Physician
  • Livonia, MI
  • NPI 1023036514
  Medicare reassignment NPD

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1922297076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18181 OAKWOOD BLVD",
            "address_2": "311",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481245032",
            "telephone_number": "313-271-8170",
            "fax_number": "313-271-8353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18181 OAKWOOD BLVD",
            "address_2": "311",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481245032",
            "telephone_number": "313-271-8170",
            "fax_number": "313-271-8353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENTONS",
        "first_name": "RICKY",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "MALLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-15",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MI",
            "license": "6301005971",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301005971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APEX BEHAVIORAL HEALTH P.L.L.C. MEDICARE GROUP PIN NO.",
            "identifier": "0N15280",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6301005971",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maryam Jelvani
• Susan M Jenison
• Elizabeth Cherita Jenkins, NP
• Jennifer L. Ozeir, M.D., P.C. (Women's Health of Dearborn)
• Abigail Margarete Schieb Jennings
• Jeremy D Copple DC PC
• Jesus a Martinez MD PC
• Jiab Suleiman, DO, P.C. (Premier Orthopedics)
• Syed Irfan Haider Jilani, D.P.T.
• Sonia Jishi

• Clinical Psychologist in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.