Provider Demographics
NPI:1629787239
Name:YMG PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:YMG PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DYNESHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MASON GRISSOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCP, MSCP
Authorized Official - Phone:217-278-0159
Mailing Address - Street 1:306 W GRAHAM DR
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9441
Mailing Address - Country:US
Mailing Address - Phone:217-278-0159
Mailing Address - Fax:
Practice Address - Street 1:701 DEVONSHIRE DR. BLD. C SUITE 132
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820
Practice Address - Country:US
Practice Address - Phone:217-278-0159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty