Provider Demographics
NPI:1588905939
Name:ANCHOR PSYCHOLOGY CENTER, PLLC
Entity type:Organization
Organization Name:ANCHOR PSYCHOLOGY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHOEMAKER, PHD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:228-875-1590
Mailing Address - Street 1:2112 BIENVILLE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3067
Mailing Address - Country:US
Mailing Address - Phone:228-875-1590
Mailing Address - Fax:228-875-1591
Practice Address - Street 1:2112 BIENVILLE BLVD STE J
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3067
Practice Address - Country:US
Practice Address - Phone:228-875-1590
Practice Address - Fax:228-875-1591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1728101YP2500X
MS53938103T00000X
MST0437106H00000X
MS1977101YP2500X
MS46-802103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03950571Medicaid
MS512I680027OtherMEDICARE PTAN