Wake Psychological Services, PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

2119 Issued in NC

Legal business name

WAKE PSYCHOLOGICAL SERVICES, PLLC

Practice address

9308 Club Hill Dr
Raleigh, NC 27617-7572

Phone

(919) 308-8470

Fax

(919) 806-0088

NPI assigned

Feb 28, 2011

Last updated

Feb 28, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tijuana Crosby, MA, LPANPI 1780722801

Title

President

Phone

(919) 308-8470

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tijuana McLeod Crosby, MA

  • Psychologist
  • Raleigh, NC
  • NPI 1780722801
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298851200000",
    "number": "1306143383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9308 CLUB HILL DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276177572",
            "telephone_number": "919-308-8470",
            "fax_number": "919-806-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9308 CLUB HILL DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276177572",
            "telephone_number": "919-308-8470",
            "fax_number": "919-806-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE PSYCHOLOGICAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-28",
        "last_updated": "2011-02-28",
        "status": "A",
        "authorized_official_last_name": "CROSBY",
        "authorized_official_first_name": "TIJUANA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-308-8470",
        "authorized_official_credential": "MA, LPA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "2119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6107407",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wake Medical Supply LLC
• Wake Nephrology Associates, P.a.
• Wake Orthopaedics, LLC
• Wake Psychiatry, PLLC
• Wake Psychological Services
• Wake Radiology Consultants PA
• Wake Radiology Diagnostic Imaging Inc.
• Wake Radiology Services, LLC
• Wake Rheumatology & Osteoporosis (Wake Rheumatology &Osteoporosis Consultants, P.A.)
• Wake Sedation Associates, LLC

• Community/Behavioral Health Agency in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.