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General NPI Number Information
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NPI Number | 1184116444
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Entity Type | Organization
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Legal Business Name | ANSEL PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 06/02/2018
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Last Update Date | 06/02/2018
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Provider Practice Location Address
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Address Line | 1716 GOVERNMENT ST STE E
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3801
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Country | US
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Telephone | 228-200-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 141 CLEAR SPRINGS CIR
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-5741
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Country | US
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Telephone | 205-792-6917
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. LISA L ANSEL
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Credential | PH.D.
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Telephone | 205-792-6917
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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 | 53926
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License Number State | MS
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