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General NPI Number Information
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NPI Number | 1568051373
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Entity Type | Organization
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Legal Business Name | MUNDY PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 3959 ELECTRIC RD STE 454
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City | ROANOKE
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State | VA
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Zip | 24018-4559
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Country | US
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Telephone | 540-529-9573
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Fax | 540-269-4365
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Provider Business Mailing Address
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Address Line | 3959 ELECTRIC RD STE 454
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City | ROANOKE
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State | VA
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Zip | 24018-4559
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Country | US
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Telephone | 540-529-9573
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Fax | 540-269-4365
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. KLAIRE MUNDY
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Credential | PSYD
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Telephone | 540-529-9573
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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 |
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License Number State |
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