Healthcare Provider Details

I. General information

NPI: 1124692405
Provider Name (Legal Business Name): PSYCHOLOGY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 S ALASKA ST STE 220
PALMER AK
99645-6378
US

IV. Provider business mailing address

6450 E VERBONCOEUR DR
WASILLA AK
99654-4550
US

V. Phone/Fax

Practice location:
  • Phone: 907-331-0220
  • Fax: 855-702-2532
Mailing address:
  • Phone: 907-715-8175
  • Fax: 855-702-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LILLIE MICHELLE GRIMES
Title or Position: DIRECTOR
Credential: PHD
Phone: 907-715-8175