Provider Demographics
NPI:1770759219
Name:PROVIDENCE PSYCHOLOGICAL SERVICES P.C.
Entity type:Organization
Organization Name:PROVIDENCE PSYCHOLOGICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-928-9887
Mailing Address - Street 1:615 BARLOW ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-4206
Mailing Address - Country:US
Mailing Address - Phone:229-928-9887
Mailing Address - Fax:229-928-9461
Practice Address - Street 1:615 BARLOW ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4206
Practice Address - Country:US
Practice Address - Phone:229-928-9887
Practice Address - Fax:229-928-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY00183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty