Organization
DIVERSIFIED PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE C KNOWLES (OFFICE MANAGER)
(903) 238-9553
Entity
Organization
Contact information
Practice address
1508 W FAIRMONT ST, SUITE C, LONGVIEW, TX 75604-6303
(903) 238-9553
(903) 291-8709
Mailing address
PO BOX 9062, LONGVIEW, TX 75608-9062
(903) 238-9553
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00145N
BLUE CROSS BLUE SHIELD
TX
05
—
079990001
—
TX
Enumeration date
05/02/2007
Last updated
09/24/2008
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