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General NPI Number Information
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NPI Number | 1659743235
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL CENTER
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 8819 MINNOW CREEK DR
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City | TALLAHASSEE
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State | FL
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Zip | 32312
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Country | US
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Telephone | 201-484-9383
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Fax |
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Provider Business Mailing Address
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Address Line | 8819 MINNOW CREEK DR
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City | TALLAHASSEE
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State | FL
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Zip | 32312
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Country | US
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Telephone | 201-484-9383
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. GERI SIDDELL
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Credential |
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Telephone | 229-226-0741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PY9289
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License Number State | FL
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