| Gateway Psychological Services, Llc | |
|
11300 4th St N Suite 115 St Petersburg FL 33716-2918 | |
| (727) 619-4477 | |
| (727) 258-2348 |
| Full Name | Gateway Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 11300 4th St N, St Petersburg, Florida |
| Authorized Official Name and Position | Michael Missory (OWNER) |
| Authorized Official Contact | 7376194477 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Psychological Services, Llc 11300 4th St N Suite 115 St Petersburg FL 33716-2918 Ph: (727) 619-4477 | Gateway Psychological Services, Llc 11300 4th St N Suite 115 St Petersburg FL 33716-2918 Ph: (727) 619-4477 |
| NPI Number | 1992257240 |
|---|---|
| Provider Enumeration Date | 11/02/2016 |
| Last Update Date | 11/02/2016 |
| Medicare PECOS PAC ID | 7719263847 |
|---|---|
| Medicare Enrollment ID | O20170404001023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992257240 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY 8375 (Florida) | Primary |
| Provider Name | Michael P Missory |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437431509 PECOS PAC ID: 5597937540 Enrollment ID: I20111017000525 |
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