Provider Demographics
NPI:1023176633
Name:PSYCHOLOGICAL CONSULTANTS PA
Entity type:Organization
Organization Name:PSYCHOLOGICAL CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:REED
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-925-9444
Mailing Address - Street 1:135 CAMBRIDGE COVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-9655
Mailing Address - Country:US
Mailing Address - Phone:601-925-9444
Mailing Address - Fax:601-924-9402
Practice Address - Street 1:135 CAMBRIDGE COVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-9655
Practice Address - Country:US
Practice Address - Phone:601-925-9444
Practice Address - Fax:601-924-9402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09685067Medicaid
R79012Medicare UPIN