Mt. Airy Psychological Services, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

MT. AIRY PSYCHOLOGICAL SERVICES, LLC

Practice address

603 E Ridgeville Blvd
Mount Airy, MD 21771-5249

Phone

(301) 200-3853

NPI assigned

Jan 3, 2025

Last updated

Jan 3, 2025By 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

Lora Speake

Title

Co-Owner

Phone

(667) 354-1201

Specialties & licenses 2

Addresses

Other names 1

• Mt. Airy Counseling, LLC Former legal business name

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

{
    "created_epoch": "1735862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1760291702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 E RIDGEVILLE BLVD",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217715249",
            "telephone_number": "667-354-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 E RIDGEVILLE BLVD",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217715249",
            "telephone_number": "301-200-3853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. AIRY PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-03",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "SPEAKE",
        "authorized_official_first_name": "LORA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "667-354-1201"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt. Airy Counseling, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; 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.