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General NPI Number Information
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NPI Number | 1700936937
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Entity Type | Organization
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Legal Business Name | CHILD & FAMILY PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 25 KENYON BROOK DR
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City | WORTHINGTON
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State | OH
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Zip | 43085-3629
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Country | US
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Telephone | 614-537-2604
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Fax |
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Provider Business Mailing Address
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Address Line | 25 KENYON BROOK DR
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City | WORTHINGTON
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State | OH
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Zip | 43085-3629
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Country | US
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Telephone | 614-537-2604
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY A FRISTAD
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Credential | PHD
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Telephone | 614-537-2604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 3860
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License Number State | OH
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