Dynamic Balance Psychology Pllc | |
1505 Shakespeare Dr Centralia WA 98531-8501 | |
(360) 360-5044 | |
Not Available |
Full Name | Dynamic Balance Psychology Pllc |
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Speciality | Psychologist |
Location | 1505 Shakespeare Dr, Centralia, Washington |
Authorized Official Name and Position | Heidi Rachelle Tennyson (CLINICAL PSYCHOLOGIST) |
Authorized Official Contact | 2083730790 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Dynamic Balance Psychology Pllc 1505 Shakespeare Dr Centralia WA 98531-8501 Ph: (360) 360-5044 | Dynamic Balance Psychology Pllc 1505 Shakespeare Dr Centralia WA 98531-8501 Ph: (360) 360-5044 |
NPI Number | 1265261010 |
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Provider Enumeration Date | 07/30/2024 |
Last Update Date | 09/04/2024 |
Certification Date | 09/04/2024 |
Medicare PECOS PAC ID | 0042751695 |
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Medicare Enrollment ID | O20240923001956 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265261010 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
Provider Name | Heidi Rachelle Tennyson |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1043404064 PECOS PAC ID: 2163698143 Enrollment ID: I20111221000313 |
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