Provider Demographics
NPI:1770967309
Name:PSYCHOLOGICAL SERVICES & CONSULTATIONS, LLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL SERVICES & CONSULTATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:352-804-1846
Mailing Address - Street 1:5481 SW 60TH ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7698
Mailing Address - Country:US
Mailing Address - Phone:352-804-1846
Mailing Address - Fax:352-509-7196
Practice Address - Street 1:5481 SW 60TH ST
Practice Address - Street 2:SUITE 502
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7698
Practice Address - Country:US
Practice Address - Phone:352-804-1846
Practice Address - Fax:352-509-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8523103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty