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General NPI Number Information
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NPI Number | 1427112853
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Entity Type | Organization
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Legal Business Name | CLEMENTS PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 1830 INDEPENDENCE SQ SUITE A
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City | ATLANTA
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State | GA
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Zip | 30338-5150
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Country | US
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Telephone | 770-375-0351
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Fax | 770-804-1241
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Provider Business Mailing Address
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Address Line | 1830 INDEPENDENCE SQ SUITE A
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City | ATLANTA
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State | GA
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Zip | 30338-5150
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Country | US
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Telephone | 770-375-0351
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Fax | 770-804-1241
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN L CLEMENTS
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Credential | PSY.D.
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Telephone | 770-375-0351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 002986
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License Number State | GA
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