Provider Demographics
NPI:1295852622
Name:GEORGE MASON UNIVERSITY CENTER FOR PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:GEORGE MASON UNIVERSITY CENTER FOR PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEHLENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-993-1371
Mailing Address - Street 1:4400 UNIVERSITY DRIVE
Mailing Address - Street 2:GEORGE MASON UNIVERSITY, MS2C6
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-993-1370
Mailing Address - Fax:703-352-0035
Practice Address - Street 1:10340 DEMOCRACY LN
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2518
Practice Address - Country:US
Practice Address - Phone:703-993-1370
Practice Address - Fax:703-993-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health