Provider Demographics
NPI:1902303563
Name:PSYCHOLOGICAL SERVICES GROUP, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:517-819-2506
Mailing Address - Street 1:670 W FIREWEED LN STE 105
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2562
Mailing Address - Country:US
Mailing Address - Phone:907-268-1572
Mailing Address - Fax:907-865-2474
Practice Address - Street 1:670 W FIREWEED LN STE 105
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2562
Practice Address - Country:US
Practice Address - Phone:907-268-1572
Practice Address - Fax:907-865-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125197103G00000X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty