Provider Demographics
NPI:1356527337
Name:PERFORMANCE PSYCHOLOGY
Entity type:Organization
Organization Name:PERFORMANCE PSYCHOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:BARNETT
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-340-5870
Mailing Address - Street 1:1150 S MILLEDGE AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-6723
Mailing Address - Country:US
Mailing Address - Phone:706-340-5870
Mailing Address - Fax:
Practice Address - Street 1:1150 S MILLEDGE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-6723
Practice Address - Country:US
Practice Address - Phone:706-340-5870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAPSY002866103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty