MEDICARE: PROFESSIONAL PSYCHOLOGICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1255674206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	3331 DUKE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4597
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3331 DUKE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4597
Country	:	US
Telephone Number	:	703-828-7115
Fax Number	:

Authorized Official
Title or Position	:	CLINICIAN
Name	:	DR. TASHNA MARIE FELIX
Credential	:	PSY.D., CSOTP
Telephone Number	:	703-828-7115

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	09/06/2013

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