Healthcare Provider Details

I. General information

NPI: 1750673950
Provider Name (Legal Business Name): NURSING HOME PSYCHOLOGICAL SERVICES OF FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 SCENIC HIGHWAY 98 UNIT 6B
DESTIN FL
32541-5772
US

IV. Provider business mailing address

85 WHISPERWOOD BLVD
SLIDELL LA
70458-1136
US

V. Phone/Fax

Practice location:
  • Phone: 985-781-8565
  • Fax: 985-781-8565
Mailing address:
  • Phone: 985-781-8565
  • Fax: 985-781-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. RODNEY D HESSON
Title or Position: OWNER/MEMBER
Credential: PSYD
Phone: 256-825-4135