Provider Demographics
NPI:1043901101
Name:AC PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:AC PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-253-1550
Mailing Address - Street 1:112 UNIVERSITY DR N STE 300
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4661
Mailing Address - Country:US
Mailing Address - Phone:701-253-1550
Mailing Address - Fax:701-299-4510
Practice Address - Street 1:112 UNIVERSITY DR N STE 300
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4661
Practice Address - Country:US
Practice Address - Phone:701-253-1550
Practice Address - Fax:701-299-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty