Provider Demographics
NPI:1972094845
Name:SPECIALIZED PSYCHOLOGY SERVICES, PLLC
Entity type:Organization
Organization Name:SPECIALIZED PSYCHOLOGY SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:T
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-234-8205
Mailing Address - Street 1:15630 W ROMA AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-6356
Mailing Address - Country:US
Mailing Address - Phone:480-234-8205
Mailing Address - Fax:
Practice Address - Street 1:501 E PLAZA CIR STE B
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4917
Practice Address - Country:US
Practice Address - Phone:480-234-8205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-004808261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health