Provider Demographics
NPI:1295043131
Name:FAMILY PSYCHOLOGY CENTER, INC.
Entity Type:Organization
Organization Name:FAMILY PSYCHOLOGY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANGELLOZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:225-767-5650
Mailing Address - Street 1:2214 QUAIL RUN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4128
Mailing Address - Country:US
Mailing Address - Phone:225-767-5650
Mailing Address - Fax:
Practice Address - Street 1:2214 QUAIL RUN DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4128
Practice Address - Country:US
Practice Address - Phone:225-767-5650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty