Provider Demographics
NPI:1205914264
Name:COMPLETE PSYCHOLOGICAL SCHOOL SERVICES
Entity type:Organization
Organization Name:COMPLETE PSYCHOLOGICAL SCHOOL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HOMER
Authorized Official - Last Name:BOURGOINE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, M ED
Authorized Official - Phone:480-644-9567
Mailing Address - Street 1:1550 N STAPLEY DR
Mailing Address - Street 2:40
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-3705
Mailing Address - Country:US
Mailing Address - Phone:480-644-9567
Mailing Address - Fax:480-644-0848
Practice Address - Street 1:1550 N STAPLEY DR
Practice Address - Street 2:40
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-3705
Practice Address - Country:US
Practice Address - Phone:480-644-9567
Practice Address - Fax:480-644-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty