Provider Demographics
NPI:1336354349
Name:PSYCHOLOGY CONSULTANTS ASSOC
Entity Type:Organization
Organization Name:PSYCHOLOGY CONSULTANTS ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-998-3920
Mailing Address - Street 1:11421 CRONHILL DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2222
Mailing Address - Country:US
Mailing Address - Phone:410-998-3920
Mailing Address - Fax:410-998-3931
Practice Address - Street 1:1205 YORK RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6210
Practice Address - Country:US
Practice Address - Phone:410-998-3920
Practice Address - Fax:410-998-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS949Medicare ID - Type Unspecified