Provider Demographics
NPI:1538408778
Name:PSYCHOLOGICAL CONSULTING & ASSESSMENT, P.C.
Entity type:Organization
Organization Name:PSYCHOLOGICAL CONSULTING & ASSESSMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:641-629-0240
Mailing Address - Street 1:710 BRUNSWIJK CIR
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7806
Mailing Address - Country:US
Mailing Address - Phone:641-629-0240
Mailing Address - Fax:641-628-2760
Practice Address - Street 1:710 BRUNSWIJK CIR
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7806
Practice Address - Country:US
Practice Address - Phone:641-629-0240
Practice Address - Fax:641-628-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00771103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty