MEDICARE: SPECIALIZED PSYCHOLOGY SOLUTIONS

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	103T00000X	Psychologist
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1912254954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED PSYCHOLOGY SOLUTIONS

Provider Business Mailing Address
First Line	:	3605 E RAMON RD
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1150
Country	:	US
Telephone Number	:	765-375-5630
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 E RAMON RD
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1150
Country	:	US
Telephone Number	:	765-375-5630
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ADAM W CASH
Credential	:	PHD.
Telephone Number	:	765-375-5630

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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