Provider Demographics
NPI:1164624458
Name:PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PODRYGULA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-852-9113
Mailing Address - Street 1:600 22ND AVE NW
Mailing Address - Street 2:NORTHLAND PROFESSIONAL BUILDING
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-0986
Mailing Address - Country:US
Mailing Address - Phone:701-852-9113
Mailing Address - Fax:701-838-0779
Practice Address - Street 1:600 22ND AVE NW
Practice Address - Street 2:NORTHLAND PROFESSIONAL BUILDING
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-0986
Practice Address - Country:US
Practice Address - Phone:701-852-9113
Practice Address - Fax:701-838-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5241OtherBCBS OF ND
ND16946Medicaid
NDR02220Medicare UPIN