Provider Demographics
NPI:1376991471
Name:PACIFIC PSYCHOLOGY SERVICES CENTER, LLC
Entity Type:Organization
Organization Name:PACIFIC PSYCHOLOGY SERVICES CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:BEVERIDGE
Authorized Official - Last Name:DENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-294-3595
Mailing Address - Street 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 621
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4402
Mailing Address - Country:US
Mailing Address - Phone:808-294-3595
Mailing Address - Fax:866-270-8635
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 621
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-294-3595
Practice Address - Fax:866-270-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 697261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health