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General NPI Number Information
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NPI Number | 1679810444
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Entity Type | Organization
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Legal Business Name | CHILD AND FAMILY PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 01/13/2013
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Last Update Date | 01/13/2013
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Provider Practice Location Address
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Address Line | 424 WASHINGTON ST STE 7
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City | COLUMBUS
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State | IN
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Zip | 47201-6790
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Country | US
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Telephone | 812-374-2282
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Fax |
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Provider Business Mailing Address
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Address Line | 424 WASHINGTON ST STE 7
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City | COLUMBUS
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State | IN
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Zip | 47201-6790
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Country | US
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Telephone | 812-374-2282
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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. JESSICA ALYCE BRYANT BISSEY
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Credential | PSYD
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Telephone | 812-374-2282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39002087A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20042096A
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License Number State | IN
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