MEDICARE: APPLIED PSYCHOLOGY CTR APC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker
3	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457446700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLIED PSYCHOLOGY CTR APC

Provider Business Mailing Address
First Line	:	904 DESOTO ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3737
Country	:	US
Telephone Number	:	228-872-8429
Fax Number	:	228-872-0226

Provider Business Practice Location Address
First Line	:	904 DESOTO ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3737
Country	:	US
Telephone Number	:	228-872-8429
Fax Number	:	228-872-0226

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	DR. STEFAN MASSONG
Credential	:	PH.D.
Telephone Number	:	228-872-8429

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/02/2013

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Directions to “APPLIED PSYCHOLOGY CTR APC ” Practice Location

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