Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | ||
Y | 103TC0700X | Clinical Psychologist | ||
N | 103G00000X | Clinical Psychologist | 071-008545 | IL |
N | 103TC0700X | Clinical Psychologist | 071-008545 | IL |
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1699112334 |
---|---|
Provider Name | Dr. Justin R. Jaramillo |
First Address | Dallas, TX 75216-7167 |
Second Address | Dallas, TX 75216-7167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 06/12/2013 |