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A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974).
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Health Service |
103TH0100X | 62 | Psychologist, Clinical |
| NPI Number | 1538556865 |
| LBN Legal business name | TLC BEHAVIORAL HEALTH AND PSYCHOLOGY CORPORATION |
| Authorized official | MICHAEL WIEDERSTEIN - (CEO, CFO) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 04/24/2015 |
| Last updated | 05/10/2016 - About 10 years ago |
| Identifiers | n/a |
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TLC BEHAVIORAL HEALTH AND PSYCHOLOGY CORPORATION