MEDICARE: COUNSELING PSYCHOLOGY ASSOCIATES

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1154593671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING PSYCHOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 5037
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-0037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 15TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2241
Country	:	US
Telephone Number	:	706-653-2221
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GABRIEL DENES
Credential	:	PH.D.
Telephone Number	:	706-653-2221

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/25/2008

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