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NPI Code Detail

MEDICARE: DIALECTIC PSYCHOLOGICAL SERVICES, LLC

MEDICARE: DIALECTIC PSYCHOLOGICAL SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist4675OH

General Provider Information

NPI Number : 1679907711
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIALECTIC PSYCHOLOGICAL SERVICES, LLC
Provider Business Mailing Address
First Line : PO BOX 8440
Second Line :
City : TOLEDO
State : OH
Zip : 43623-0440
Country : US
Telephone Number : 419-885-0200
Fax Number : 419-885-0203
Provider Business Practice Location Address
First Line : 1011 N BYRNE RD
Second Line :
City : TOLEDO
State : OH
Zip : 43607-2710
Country : US
Telephone Number : 419-788-7019
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DAVID K CONNELL
Credential : PHD
Telephone Number : 419-788-7019
Provider Enumeration Date : 08/26/2013
Last Update Date : 09/27/2013

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