Provider Demographics
NPI:1285227884
Name:FRIENDLY CITY PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:FRIENDLY CITY PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KOON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-208-2280
Mailing Address - Street 1:3230 PEOPLES DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-7623
Mailing Address - Country:US
Mailing Address - Phone:540-209-8182
Mailing Address - Fax:888-854-5854
Practice Address - Street 1:3230 PEOPLES DR STE 110
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-7623
Practice Address - Country:US
Practice Address - Phone:540-209-8182
Practice Address - Fax:888-854-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty