Provider Demographics
NPI:1750673950
Name:NURSING HOME PSYCHOLOGICAL SERVICES OF FL LLC
Entity Type:Organization
Organization Name:NURSING HOME PSYCHOLOGICAL SERVICES OF FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HESSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:256-825-4135
Mailing Address - Street 1:85 WHISPERWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1136
Mailing Address - Country:US
Mailing Address - Phone:985-781-8565
Mailing Address - Fax:985-781-5395
Practice Address - Street 1:3795 SCENIC HIGHWAY 98 UNIT 6B
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5772
Practice Address - Country:US
Practice Address - Phone:985-781-8565
Practice Address - Fax:985-781-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty