Provider Demographics
NPI:1639277593
Name:PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLIDEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-826-1699
Mailing Address - Street 1:1915 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2852
Mailing Address - Country:US
Mailing Address - Phone:334-826-1699
Mailing Address - Fax:334-826-1629
Practice Address - Street 1:1915 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2852
Practice Address - Country:US
Practice Address - Phone:334-826-1699
Practice Address - Fax:334-826-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTAX ID NUMBER