Provider Demographics
NPI:1477159622
Name:DYNAMIC PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:DYNAMIC PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ZECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-561-0168
Mailing Address - Street 1:432 ST JOHN RD # 100
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7336
Mailing Address - Country:US
Mailing Address - Phone:219-561-0168
Mailing Address - Fax:
Practice Address - Street 1:619 FRANKLIN ST STE 203
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3411
Practice Address - Country:US
Practice Address - Phone:219-561-0168
Practice Address - Fax:219-666-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty