Provider Demographics
NPI:1356495329
Name:PSYCHOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:PSYCHOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-256-1021
Mailing Address - Street 1:4801 INDIAN SCHOOL RD NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4968
Mailing Address - Country:US
Mailing Address - Phone:505-256-1021
Mailing Address - Fax:505-268-7442
Practice Address - Street 1:4801 INDIAN SCHOOL RD NE STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4968
Practice Address - Country:US
Practice Address - Phone:505-256-1021
Practice Address - Fax:505-268-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM529103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty