Provider Demographics
NPI:1134282015
Name:PSYCHOLOGICAL CARE AND CONSULTATION, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL CARE AND CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAKALLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-281-8526
Mailing Address - Street 1:PO BOX 358372
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-8372
Mailing Address - Country:US
Mailing Address - Phone:352-281-8526
Mailing Address - Fax:352-331-8341
Practice Address - Street 1:9214 NW 24TH LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-9143
Practice Address - Country:US
Practice Address - Phone:352-281-8526
Practice Address - Fax:352-331-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty