Provider Demographics
NPI:1821126301
Name:SIMON PSYCHOLOGICAL SERVICES, INC
Entity Type:Organization
Organization Name:SIMON PSYCHOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TALKINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:352-615-8884
Mailing Address - Street 1:PO BOX 830323
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34483-0323
Mailing Address - Country:US
Mailing Address - Phone:352-615-8884
Mailing Address - Fax:321-247-6970
Practice Address - Street 1:217 SE 1ST AVE STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-2161
Practice Address - Country:US
Practice Address - Phone:352-615-8884
Practice Address - Fax:321-247-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7391103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB158Medicare PIN
FLAB159ZMedicare PIN