Psychological Assessment and Consulting, PC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20041639A Issued in IN

Legal business name

PSYCHOLOGICAL ASSESSMENT AND CONSULTING, PC

Practice address

1806 W Royale Dr
Muncie, IN 47304-2243

Phone

(765) 755-0052

Fax

(765) 755-0052

NPI assigned

Aug 25, 2008

Organization subpart

No

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

Authorized official

Name

Grace Kimmerling, PHDNPI 1942871306

Title

President

Phone

(765) 755-0052

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Willow Branch Counseling Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Grace Marie Kimmerling

  • Mental Health Counselor
  • Muncie, IN
  • NPI 1942871306
  Medicare reassignment Care Compare group NPD Authorized official
• Ashley Lynn Boester-Dean, PH.D., HSPP

  • Counseling Psychologist
  • Muncie, IN
  • NPI 1457848459
  Medicare reassignment Care Compare group NPD
• Dana Elaine Thomas, LMHC

  • Mental Health Counselor
  • Muncie, IN
  • NPI 1164039186
  Medicare reassignment NPD
• Andrea Grace Trinidad

  • Mental Health Counselor
  • Muncie, IN
  • NPI 1255964367
  NPD

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

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1962659607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1806 W ROYALE DR",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473042243",
            "telephone_number": "765-755-0052",
            "fax_number": "765-755-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1806 W ROYALE DR",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473042243",
            "telephone_number": "765-755-0052",
            "fax_number": "765-755-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL ASSESSMENT AND CONSULTING, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-25",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "KIMMERLING",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "765-755-0052",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20041639A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200911770A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11646258",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS PIN",
            "identifier": "000000588248",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Branch Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brooke Price, RBT
• Dezi Price
• Kelly Price
• Primary Telecare LLC
• Taylor Privett, RBT
• Psychology and Beyond
• Mandy Lynn Puckett, R.D., M.A., C.D.
• Brandy Latrice Pugh
• Pulaski Memorial Hospital
• Pulaski Memorial Hospital

• Psychologist in Muncie, IN
• Providers in Muncie, IN by specialty
• Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.