Provider Demographics
NPI:1427112853
Name:CLEMENTS PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:CLEMENTS PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-375-0351
Mailing Address - Street 1:1830 INDEPENDENCE SQ
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5150
Mailing Address - Country:US
Mailing Address - Phone:770-375-0351
Mailing Address - Fax:770-804-1241
Practice Address - Street 1:1830 INDEPENDENCE SQ
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5150
Practice Address - Country:US
Practice Address - Phone:770-375-0351
Practice Address - Fax:770-804-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002986103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty