Provider Demographics
NPI:1073259065
Name:FOUCHE PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:FOUCHE PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:BELAY
Authorized Official - Last Name:FOUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-230-6947
Mailing Address - Street 1:119 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-8697
Mailing Address - Country:US
Mailing Address - Phone:860-230-6947
Mailing Address - Fax:
Practice Address - Street 1:3006 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3589
Practice Address - Country:US
Practice Address - Phone:860-230-6947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty