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General NPI Number Information
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NPI Number | 1215587001
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICES GROUP, LLC
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 707 A ST STE 115
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City | ANCHORAGE
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State | AK
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Zip | 99501-3600
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Country | US
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Telephone | 907-268-1572
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Fax | 907-865-2474
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Provider Business Mailing Address
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Address Line | 707 A ST STE 115
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City | ANCHORAGE
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State | AK
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Zip | 99501-3600
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Country | US
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Telephone | 907-268-1572
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Fax | 907-865-2474
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | KARA STOCKER
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Credential | PSYD
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Telephone | 907-268-1572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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