Provider Demographics
NPI:1568051373
Name:MUNDY PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:MUNDY PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:540-529-9573
Mailing Address - Street 1:3959 ELECTRIC RD STE 454
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4559
Mailing Address - Country:US
Mailing Address - Phone:540-529-9573
Mailing Address - Fax:540-269-4365
Practice Address - Street 1:3959 ELECTRIC RD STE 454
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4559
Practice Address - Country:US
Practice Address - Phone:540-529-9573
Practice Address - Fax:540-269-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty