DR. AMELIA BLACK PH.D., CGP
NPI 1770192379
Psychologist in Las Vegas, NV

Active since July 29, 2020Opted out of Medicare · through Sep 15, 2026
CEB 226 4505 S. MARYLAND PKWY, BOX #453033, LAS VEGAS, NV 89154(702) 895-1532 Get Directions Write a Review

NPPES record last updated: August 2, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 2, 2021, Jul 29, 2020 (2 updates tracked since 2020).

About Dr. Amelia Black Ph.d., Cgp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. AMELIA BLACK PH.D., CGP (NPI 1770192379) is an individual psychologist in Las Vegas, Nevada, licensed in Nevada (PY0928) and active in the NPI registry since July 2020. She has opted out of Medicare through September 15, 2026 and maintains a secondary practice location in Henderson.

NPPES Registry Identity

NPI1770192379
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. AMELIA BLACKCredential: PH.D., CGP
Location AddressCEB 226 4505 S. MARYLAND PKWY, BOX #453033Las Vegas, NV 89154
Mailing AddressCeb 226 4505 S. Maryland Pkwy, Box #453033Las Vegas, NV 89154 · (702) 895-1532
Sole ProprietorYes
Enumeration DateJuly 29, 2020
Last NPPES UpdateAugust 2, 20212 updates tracked since enumeration
NPPES CertifiedAugust 2, 2021
NPI 1770192379 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in NV · PY0928
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
CEB 226 4505 S. MARYLAND PKWY, Las Vegas, NV 89154

Secondary Practice Location 1

Location 12460 Paseo Verde Pkwy Ste 100Henderson, NV 89074-7136 · Phone (702) 508-9181

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Dr. Amelia Black Ph.d., Cgp has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 15, 2020 through September 15, 2026.

Opt-Out Effective DateSeptember 15, 2020
Opt-Out In Effect ThroughSeptember 15, 2026Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Amelia Black's NPI number?

The NPI number for Amelia Black is 1770192379. It was assigned to this individual provider in the NPPES registry on July 29, 2020.

Where is Amelia Black located?

Amelia Black practices at Ceb 226 4505 S. Maryland Pkwy Box #453033, Las Vegas, NV 89154. The listed phone number is (702) 895-1532.

What is Amelia Black's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Amelia Black enrolled in Medicare?

No. Amelia Black has opted out of Medicare through September 15, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Amelia Black was last updated on August 2, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.