Provider Demographics
NPI:1194041301
Name:JASON S BERMAN, PHD, PLLC
Entity Type:Organization
Organization Name:JASON S BERMAN, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-929-9244
Mailing Address - Street 1:1721 W PLANO PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8633
Mailing Address - Country:US
Mailing Address - Phone:214-929-9244
Mailing Address - Fax:972-364-9095
Practice Address - Street 1:1721 W PLANO PKWY STE 107
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8633
Practice Address - Country:US
Practice Address - Phone:214-929-9244
Practice Address - Fax:972-364-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34212103TC0700X
MO2011006684103TC0700X
KS1945103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34212OtherTEXAS BOARD OF EXAMINERS OF PSYCHOLOGY
11987351OtherCAQH