Provider Demographics
NPI:1902801210
Name:BAY AREA PSYCHOLOGICAL CONSULTANTS
Entity Type:Organization
Organization Name:BAY AREA PSYCHOLOGICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:TALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:850-729-0303
Mailing Address - Street 1:1417 PARTIN DR N
Mailing Address - Street 2:STE 1
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1426
Mailing Address - Country:US
Mailing Address - Phone:850-729-0303
Mailing Address - Fax:850-729-0305
Practice Address - Street 1:1417 PARTIN DR N
Practice Address - Street 2:STE 1
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1426
Practice Address - Country:US
Practice Address - Phone:850-729-0303
Practice Address - Fax:850-729-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4285103T00000X
FLPY5264103T00000X
FLPY4031103T00000X
FLPY7250103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicare UPIN
FL45577Medicare ID - Type UnspecifiedMEDICARE GRP NUMBER