Provider Demographics
NPI:1952449621
Name:NORTH FLORIDA PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:NORTH FLORIDA PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:386-326-4009
Mailing Address - Street 1:421 SAINT JOHNS AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-4741
Mailing Address - Country:US
Mailing Address - Phone:386-326-4009
Mailing Address - Fax:386-328-7733
Practice Address - Street 1:421 SAINT JOHNS AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4741
Practice Address - Country:US
Practice Address - Phone:386-326-4009
Practice Address - Fax:386-328-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 2384103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4363Medicare ID - Type UnspecifiedGROUP NUMBER