Bay Area Psychological Consultants
Organization Active NPI Psychologist · Niceville, FL
NPI 1902801210 · NPPES record last updated Apr 20, 2008
Key facts
- NPI
- 1902801210
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychologist 103T00000X
- License
- PY4285 (FL)
- Legal business name
- BAY AREA PSYCHOLOGICAL CONSULTANTS
- Practice address
- 1417 Partin Dr N
Ste 1
Niceville, FL 32578-1426 - Phone
- (850) 729-0303
- Fax
- (850) 729-0305
- NPI assigned
- Jun 15, 2005
- Organization subpart
- No
Authorized official
- Name
- Michael L Tallman, PSY.D
- Title
- President
- Phone
- (850) 729-0303
Practitioners 13
-
Bonnie G Benshoof, PHD
-
Angela Kathryn McManus, L.C.S.W
-
Kellie Hebert Rogers, LCSW
-
Sara Lane Williamson, MSW, LCSW
-
Jordin Elise Early, LCSW
-
Kristina Maria White, M.ED; LMFT
-
James Allen Donner, PSYD
-
Joy Makela, LMHC, LSP, LPC, NCC
-
Gretchen Chapman Tyler, PH.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070822000815 | FL | Part B Supplier - Clinic/Group Practice | 3779675756 |
Receives reassigned benefits from 10 practitioners Practice locations: Niceville, FL |
National Provider Directory
Locations
1417 Partin Dr N
Ste 1
Niceville, FL 32578
Phone (850) 729-0303
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | PY4285 | FL | Yes |
| Psychologist |
103T00000X | PY5264 | FL | |
| Psychologist |
103T00000X | PY4031 | FL | |
| Psychologist |
103T00000X | PY7250 | FL |
Addresses
Primary practice location
1417 Partin Dr N
Ste 1
Niceville, FL 32578-1426
Mailing address
1417 Partin Dr N
Ste 1
Niceville, FL 32578-1426
Phone (850) 729-0303
Other providers in Niceville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.