MEDICARE: GROVE CITY PSYCHOLOGICAL SERVICES 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	101YP2500X	Professional Counselor
2	103TC1900X	Counseling Psychologist
3	1041C0700X	Clinical Social Worker
4	103T00000X	Psychologist	5180	OH

General Provider Information

NPI Number	:	1952465668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROVE CITY PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	3774 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123
Country	:	US
Telephone Number	:	614-871-0035
Fax Number	:	614-539-0069

Provider Business Practice Location Address
First Line	:	3774 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2235
Country	:	US
Telephone Number	:	614-871-0035
Fax Number	:	614-539-0069

Authorized Official
Title or Position	:	CO OWNER
Name	:	JOCELYN GOOD
Credential	:	PHD
Telephone Number	:	614-871-0035

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	04/11/2023

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Directions to “GROVE CITY PSYCHOLOGICAL SERVICES LLC ” Practice Location

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