Healthcare Provider Details

I. General information

NPI: 1215587001
Provider Name (Legal Business Name): PSYCHOLOGICAL SERVICES GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 A ST STE 115
ANCHORAGE AK
99501-3600
US

IV. Provider business mailing address

707 A ST STE 115
ANCHORAGE AK
99501-3600
US

V. Phone/Fax

Practice location:
  • Phone: 907-268-1572
  • Fax: 907-865-2474
Mailing address:
  • Phone: 907-268-1572
  • Fax: 907-865-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: KARA STOCKER
Title or Position: NEUROPSYCHOLOGIST
Credential: PSYD
Phone: 907-268-1572