Organization
JASPER PSYCHOLOGICAL SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDELL JASPER PH.D. (OWNER)
(980) 229-3788
Entity
Organization
Contact information
Practice address
1107 MINT STREET, SUITE 104, CHARLOTTE, NC 28203
(980) 229-3788
Mailing address
1107 MINT STREET, SUITE 104, CHARLOTTE, NC 28203
(980) 229-3788
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
103TF0000X
Family Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
08/07/2012
Last updated
08/07/2012
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