Provider Demographics
NPI:1033254529
Name:CONSULTING PSYCHOLOGICAL RESOURCES, LLC
Entity Type:Organization
Organization Name:CONSULTING PSYCHOLOGICAL RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEATER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:228-594-9010
Mailing Address - Street 1:1907 PASS RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4101
Mailing Address - Country:US
Mailing Address - Phone:228-594-9010
Mailing Address - Fax:228-594-9012
Practice Address - Street 1:1907 PASS RD
Practice Address - Street 2:SUITE G
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4101
Practice Address - Country:US
Practice Address - Phone:228-594-9010
Practice Address - Fax:228-594-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02883Medicare ID - Type UnspecifiedGROUP ID