| Clinical Psychology Services, Llc | |
|
913 Gulf Breeze Pkwy Ste 36 Gulf Breeze FL 32561-4729 | |
| (850) 319-9102 | |
| Not Available |
| Full Name | Clinical Psychology Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 913 Gulf Breeze Pkwy Ste 36, Gulf Breeze, Florida |
| Authorized Official Name and Position | Tatiana Grant (PSYCHOLOGY) |
| Authorized Official Contact | 8503199102 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinical Psychology Services, Llc 201 S Sunset Blvd Gulf Breeze FL 32561-4313 Ph: (850) 319-9102 | Clinical Psychology Services, Llc 913 Gulf Breeze Pkwy Ste 36 Gulf Breeze FL 32561-4729 Ph: (850) 319-9102 |
| NPI Number | 1437754876 |
|---|---|
| Provider Enumeration Date | 12/03/2020 |
| Last Update Date | 12/03/2020 |
| Certification Date | 12/03/2020 |
| Medicare PECOS PAC ID | 8325453236 |
|---|---|
| Medicare Enrollment ID | O20211230000259 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437754876 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tatiana C Grant |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134771629 PECOS PAC ID: 6608281514 Enrollment ID: I20210225003199 |
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