Mobile Psychology, LLC
Organization Active NPI Psychologist · Hanson, KY
NPI 1669724357 · NPPES record last updated Sep 15, 2014
Key facts
- NPI
- 1669724357
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychologist 103T00000X
- License
- 1355 (KY)
- Legal business name
- MOBILE PSYCHOLOGY, LLC
- Practice address
- 345 Leroy Road
Hanson, KY 42413-9657 - Phone
- (270) 875-2544
- Fax
- (270) 342-5411
- NPI assigned
- Oct 5, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Rita Marie Jungblom, PSY.D.
- Title
- Owner
- Phone
- (270) 875-2544
Practitioners 1
-
Richard Wayne Lake, LMFT
National Provider Directory
Locations
1830 Lantaff Blvd
#200
Madisonville, KY 42431
Phone (270) 875-2544
1840 Lantaff Blvd
#201
Madisonville, KY 42431
Phone (270) 875-2544
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | 1355 | KY | Yes |
Addresses
Primary practice location
345 Leroy Road
Hanson, KY 42413-9657
Mailing address
345 Leroy Road
Hanson, KY 42413-9657
Phone (270) 875-2544
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100240540 | Medicaid | KY | |
| 7100297310 | Medicaid | KY |
Other providers in Hanson, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.