Basic Information
| Provider Information | |||||||||
| NPI: | 1053545350 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NURSING HOME PSYCHOLOGICAL SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 398 E COLUMBUS ST | ||||||||
| Address2: | |||||||||
| City: | DADEVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368531402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568254135 | ||||||||
| FaxNumber: | 2568254137 | ||||||||
| Practice Location | |||||||||
| Address1: | 398 E COLUMBUS ST | ||||||||
| Address2: | |||||||||
| City: | DADEVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368531402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568254135 | ||||||||
| FaxNumber: | 2568254137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2009 | ||||||||
| LastUpdateDate: | 05/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | HESSON | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2568254135 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.