Provider Demographics
NPI:1659743235
Name:PSYCHOLOGICAL CENTER
Entity Type:Organization
Organization Name:PSYCHOLOGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-226-0741
Mailing Address - Street 1:8819 MINNOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312
Mailing Address - Country:US
Mailing Address - Phone:201-484-9383
Mailing Address - Fax:
Practice Address - Street 1:8819 MINNOW CREEK DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312
Practice Address - Country:US
Practice Address - Phone:201-484-9383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9289251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health