MEDICARE: PSYCHOLOGICAL ASSOCIATES INC.

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	101YM0800X	Mental Health Counselor	E0004118	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902198120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGICAL ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	2699 E MAIN ST STE 105
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2533
Country	:	US
Telephone Number	:	614-235-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-3707
Country	:	US
Telephone Number	:	614-235-2000
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. STEPHEN MICHAEL MUNCY
Credential	:	PH.D
Telephone Number	:	614-235-2000

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	04/10/2019

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