Provider Demographics
NPI:1164703047
Name:AEGIS PSYCHOLOGICAL CONSULTING LLC
Entity Type:Organization
Organization Name:AEGIS PSYCHOLOGICAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLAOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMBOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-262-6175
Mailing Address - Street 1:P.O. BOX 2621
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766
Mailing Address - Country:US
Mailing Address - Phone:903-262-6175
Mailing Address - Fax:903-534-9311
Practice Address - Street 1:208 E. RUSK ST.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766
Practice Address - Country:US
Practice Address - Phone:903-262-6175
Practice Address - Fax:903-534-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23624103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty