Provider Demographics
NPI:1518365790
Name:CRESCENT CITY PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:CRESCENT CITY PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SKELLIE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:504-481-2099
Mailing Address - Street 1:137 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5244
Mailing Address - Country:US
Mailing Address - Phone:504-481-2099
Mailing Address - Fax:407-567-7870
Practice Address - Street 1:137 N CLARK ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5244
Practice Address - Country:US
Practice Address - Phone:504-481-2099
Practice Address - Fax:407-567-7870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty