| Dodge Psychology Practice, Llc | |
|
18975 W 115th Ter Olathe KS 66061-6542 | |
| (913) 232-6861 | |
| Not Available |
| Full Name | Dodge Psychology Practice, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 18975 W 115th Ter, Olathe, Kansas |
| Authorized Official Name and Position | Timothy D Dodge (OWNER) |
| Authorized Official Contact | 9132326861 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dodge Psychology Practice, Llc 18975 W 115th Ter Olathe KS 66061-6542 Ph: (913) 232-6861 | Dodge Psychology Practice, Llc 18975 W 115th Ter Olathe KS 66061-6542 Ph: (913) 232-6861 |
| NPI Number | 1962701755 |
|---|---|
| Provider Enumeration Date | 03/20/2011 |
| Last Update Date | 09/05/2012 |
| Medicare PECOS PAC ID | 8628254034 |
|---|---|
| Medicare Enrollment ID | O20110519000753 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962701755 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2002011102 (Missouri) | Primary |
| Provider Name | Timothy D Dodge |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598926362 PECOS PAC ID: 9335203793 Enrollment ID: I20090219000071 |
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