Healthcare Provider Details

I. General information

NPI: 1437754876
Provider Name (Legal Business Name): CLINICAL PSYCHOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 E CERVANTES ST
PENSACOLA FL
32503-6336
US

IV. Provider business mailing address

2810 E CERVANTES ST
PENSACOLA FL
32503-6336
US

V. Phone/Fax

Practice location:
  • Phone: 850-319-9102
  • Fax:
Mailing address:
  • Phone: 850-319-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TATIANA GRANT
Title or Position: PSYCHOLOGY
Credential: PSYD
Phone: 850-319-9102