MEDICARE: CAPITAL PSYCHOLOGY CONSULTANTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1144738568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL PSYCHOLOGY CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	3050 HIGHLAND OAKS TER UNIT 1
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-3841
Country	:	US
Telephone Number	:	850-224-5801
Fax Number	:	850-224-6459

Provider Business Practice Location Address
First Line	:	3050 HIGHLAND OAKS TER UNIT 1
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-3841
Country	:	US
Telephone Number	:	850-224-5801
Fax Number	:	850-224-6459

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. MARIE HUME GUILFORD
Credential	:	PH.D.
Telephone Number	:	850-224-5801

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	07/11/2024

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