Provider Demographics
NPI:1295952992
Name:NURSING HOME PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:NURSING HOME PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HESSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:601-749-9477
Mailing Address - Street 1:85 WHISPERWOOD BLVD STE 2R
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1136
Mailing Address - Country:US
Mailing Address - Phone:985-781-8565
Mailing Address - Fax:985-781-5395
Practice Address - Street 1:160 ARCHIE WHEAT RD
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-5515
Practice Address - Country:US
Practice Address - Phone:985-781-8565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC04530Medicare PIN