| Organization Name: | AMELIA PSYCHOLOGICAL SERVICES, LLC |
| NPI Number: | 1174955207 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERNEST PAUL BICKNELL (SOLE MBR) |
| Mailing Address: | 1890 S 14th St Suite 306 Fernandina Beach |
| State: | FL US |
| Postal Code: | 320344740 |
| Phone Number: | 9044327833 |
| Fax Number: | 9044327831 |
| NPI Enumeration Date: | 07/31/2013 |
| NPI Last Update Date: | 07/31/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |