Provider Demographics
NPI:1528832615
Name:ANT PSYCHOLOGICAL GROUP PLLC
Entity type:Organization
Organization Name:ANT PSYCHOLOGICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SUESS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:308-360-3606
Mailing Address - Street 1:300 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1631
Mailing Address - Country:US
Mailing Address - Phone:308-360-3606
Mailing Address - Fax:
Practice Address - Street 1:300 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1631
Practice Address - Country:US
Practice Address - Phone:308-360-3606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)