Provider Demographics
NPI:1760115554
Name:FLYING ANCHOR PSYCHOLOGY PC
Entity Type:Organization
Organization Name:FLYING ANCHOR PSYCHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHGRUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-330-4321
Mailing Address - Street 1:1959 LAKESPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4403
Mailing Address - Country:US
Mailing Address - Phone:312-330-4321
Mailing Address - Fax:
Practice Address - Street 1:1959 LAKESPRINGS CIR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4403
Practice Address - Country:US
Practice Address - Phone:312-330-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty