Provider Demographics
NPI:1851448633
Name:PSYCHOLOGICAL AND FAMILY CONSULTANTS INC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL AND FAMILY CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST PRESIDENT OF CORP.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-575-8954
Mailing Address - Street 1:1254 OCALA RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-1548
Mailing Address - Country:US
Mailing Address - Phone:850-575-8954
Mailing Address - Fax:850-575-9445
Practice Address - Street 1:1254 OCALA RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-1548
Practice Address - Country:US
Practice Address - Phone:850-575-8954
Practice Address - Fax:850-575-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 2886103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTAN FM732AMedicare PIN