Provider Demographics
NPI:1215299706
Name:COMMONWEALTH PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:COMMONWEALTH PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGICAL
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-338-8024
Mailing Address - Street 1:147 MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1147
Mailing Address - Country:US
Mailing Address - Phone:859-338-8024
Mailing Address - Fax:606-432-3890
Practice Address - Street 1:147 MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1147
Practice Address - Country:US
Practice Address - Phone:859-338-8024
Practice Address - Fax:606-432-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty