Provider Demographics
NPI:1457446700
Name:APPLIED PSYCHOLOGY CTR APC
Entity Type:Organization
Organization Name:APPLIED PSYCHOLOGY CTR APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:228-872-8429
Mailing Address - Street 1:904 DESOTO ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3737
Mailing Address - Country:US
Mailing Address - Phone:228-872-8429
Mailing Address - Fax:228-872-0226
Practice Address - Street 1:904 DESOTO ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3737
Practice Address - Country:US
Practice Address - Phone:228-872-8429
Practice Address - Fax:228-872-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05905039Medicaid
MS05905039Medicaid