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General NPI Number Information
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NPI Number | 1023176633
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL CONSULTANTS PA
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 135 CAMBRIDGE COVE
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City | CLINTON
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State | MS
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Zip | 39056-9655
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Country | US
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Telephone | 601-925-9444
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Fax | 601-924-9402
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Provider Business Mailing Address
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Address Line | 135 CAMBRIDGE COVE
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City | CLINTON
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State | MS
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Zip | 39056-9655
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Country | US
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Telephone | 601-925-9444
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Fax | 601-924-9402
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BILLY REED FOX
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Credential | PHD
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Telephone | 601-925-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 198
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License Number State | MS
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