1275935033 NPI number — PSYCHOLOGICAL ASSESSMENT SERVICES, LLC

Table of content: (NPI 1275935033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275935033 NPI number — PSYCHOLOGICAL ASSESSMENT SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHOLOGICAL ASSESSMENT SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275935033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2380 N 124TH ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUWATOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-1071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-443-1773
Provider Business Mailing Address Fax Number:
414-443-1747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2380 N 124TH ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUWATOSA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-1071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-443-1773
Provider Business Practice Location Address Fax Number:
414-443-1747
Provider Enumeration Date:
09/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GUST-BREY
Authorized Official First Name:
KARYN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PARTNER/LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
414-443-1773

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1619072170 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861622524 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com