Provider Demographics
NPI:1225079114
Name:DAVID C GHOSTLEY PSYD INC
Entity Type:Organization
Organization Name:DAVID C GHOSTLEY PSYD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:GHOSTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSY,D
Authorized Official - Phone:334-699-1620
Mailing Address - Street 1:202 N BELL ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4310
Mailing Address - Country:US
Mailing Address - Phone:334-699-1620
Mailing Address - Fax:
Practice Address - Street 1:202 N BELL ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4310
Practice Address - Country:US
Practice Address - Phone:334-699-1620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID GHOSTLEY PSYD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1262103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051521304Medicare ID - Type UnspecifiedPROVIDER NUMBER