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General NPI Number Information
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NPI Number | 1164872867
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Entity Type | Organization
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Legal Business Name | FORENSIC PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 665 HIGHWAY 51
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City | RIDGELAND
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State | MS
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Zip | 39157-2136
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Country | US
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Telephone | 601-707-5023
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Fax |
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Provider Business Mailing Address
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Address Line | 1490 W GOVERNMENT ST SUITE 7
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City | BRANDON
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State | MS
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Zip | 39042-3024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. AMANDA L GUGLIANO
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Credential | PSY.D.
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Telephone | 602-740-7096
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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 | 50875
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License Number State | MS
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