1033142757 NPI number — PRACTICE OF CLINICAL PSYCHOLOGY INC

Table of content: (NPI 1033142757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033142757 NPI number — PRACTICE OF CLINICAL PSYCHOLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRACTICE OF CLINICAL PSYCHOLOGY INC
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:
1033142757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 W MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45805-2730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-227-5515
Provider Business Mailing Address Fax Number:
419-227-8827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45805-2730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-227-5515
Provider Business Practice Location Address Fax Number:
419-227-8827
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZIMMERMAN
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT/TREASURER
Authorized Official Telephone Number:
419-227-5515

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1484 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com