Provider Demographics
NPI:1588685465
Name:FREDERICK PSYCHOLOGY CENTER LLC
Entity Type:Organization
Organization Name:FREDERICK PSYCHOLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GIBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-695-6455
Mailing Address - Street 1:97 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4373
Mailing Address - Country:US
Mailing Address - Phone:301-695-6455
Mailing Address - Fax:301-695-6456
Practice Address - Street 1:97 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4373
Practice Address - Country:US
Practice Address - Phone:301-695-6455
Practice Address - Fax:301-695-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)