1255519187 NPI number — RESERVE PSYCHOLOGICAL CONSULTANTS INC

Table of content: (NPI 1255519187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255519187 NPI number — RESERVE PSYCHOLOGICAL CONSULTANTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESERVE PSYCHOLOGICAL CONSULTANTS 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:
1255519187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 PORTAGE TRAIL EX W
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CUYAHOGA FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44223-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-929-1326
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 PORTAGE TRAIL EX W
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CUYAHOGA FALLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44223-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-929-1326
Provider Business Practice Location Address Fax Number:
330-929-1327
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MICHELSON
Authorized Official First Name:
PAMULA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
330-929-1326

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; 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