Provider Demographics
NPI:1801271481
Name:PSYCHOLOGICAL & CONSULTATION SERVICES
Entity type:Organization
Organization Name:PSYCHOLOGICAL & CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:SHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,
Authorized Official - Phone:602-402-9042
Mailing Address - Street 1:414 S MILL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-2845
Mailing Address - Country:US
Mailing Address - Phone:602-402-9042
Mailing Address - Fax:480-829-9237
Practice Address - Street 1:414 S MILL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2845
Practice Address - Country:US
Practice Address - Phone:602-402-9042
Practice Address - Fax:480-829-9237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3029103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty