Provider Demographics
NPI:1679810444
Name:CHILD AND FAMILY PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:CHILD AND FAMILY PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ALYCE BRYANT
Authorized Official - Last Name:BISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:812-374-2282
Mailing Address - Street 1:424 WASHINGTON ST STE 7
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6790
Mailing Address - Country:US
Mailing Address - Phone:812-374-2282
Mailing Address - Fax:
Practice Address - Street 1:424 WASHINGTON ST STE 7
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6790
Practice Address - Country:US
Practice Address - Phone:812-374-2282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002087A101YM0800X
IN20042096A103TC0700X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty