Provider Demographics
NPI:1770592818
Name:APPLIED PSYCHOLOGICAL SERVICE, INC.
Entity type:Organization
Organization Name:APPLIED PSYCHOLOGICAL SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-346-3664
Mailing Address - Street 1:74075 EL PASEO
Mailing Address - Street 2:SUITE A-12
Mailing Address - City:PALM DESSERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4146
Mailing Address - Country:US
Mailing Address - Phone:760-346-3664
Mailing Address - Fax:760-346-7117
Practice Address - Street 1:74075 EL PASEO
Practice Address - Street 2:SUITE A-12
Practice Address - City:PALM DESSERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4146
Practice Address - Country:US
Practice Address - Phone:760-346-3664
Practice Address - Fax:760-346-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ99693ZMedicare UPIN
CAZZZ99693ZMedicare ID - Type Unspecified