Provider Demographics
NPI:1376820118
Name:ADDICTIONS AND STRESS CLINICS LTD
Entity Type:Organization
Organization Name:ADDICTIONS AND STRESS CLINICS LTD
Other - Org Name:ASC PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMARIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:507-345-4679
Mailing Address - Street 1:11 CIVIC CENTER PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7718
Mailing Address - Country:US
Mailing Address - Phone:507-345-4679
Mailing Address - Fax:507-345-8685
Practice Address - Street 1:11 CIVIC CENTER PLZ STE 205
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7718
Practice Address - Country:US
Practice Address - Phone:507-345-4679
Practice Address - Fax:507-345-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00325101Y00000X
MNLP1673103T00000X
MNLP4863103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty