Provider Demographics
NPI:1750060604
Name:KEYSTONE PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:KEYSTONE PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-275-0282
Mailing Address - Street 1:155 E TARPON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 E TARPON AVE STE 4
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3451
Practice Address - Country:US
Practice Address - Phone:727-275-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty