Provider Demographics
NPI:1568644854
Name:PSYCHOLOGICAL CONSULTING SERVICES
Entity Type:Organization
Organization Name:PSYCHOLOGICAL CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BELLEFANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:423-928-8001
Mailing Address - Street 1:112 E MYRTLE AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601
Mailing Address - Country:US
Mailing Address - Phone:423-928-8001
Mailing Address - Fax:
Practice Address - Street 1:112 E MYRTLE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601
Practice Address - Country:US
Practice Address - Phone:423-928-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty