Provider Demographics
NPI:1396580163
Name:DMHG PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:DMHG PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DECRUISE-OATES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:478-284-3985
Mailing Address - Street 1:2086 JODECO RD # 1219
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5220
Mailing Address - Country:US
Mailing Address - Phone:478-284-3985
Mailing Address - Fax:
Practice Address - Street 1:2450 VINSON HWY SE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4881
Practice Address - Country:US
Practice Address - Phone:478-284-3985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty