Healthcare Provider Details

I. General information

NPI: 1851199731
Provider Name (Legal Business Name): CALDWELL PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 COUNTY ROAD 25
ARCHBOLD OH
43502-9166
US

IV. Provider business mailing address

151 CLAIRHAVEN DR
HUDSON OH
44236-3310
US

V. Phone/Fax

Practice location:
  • Phone: 419-277-3569
  • Fax:
Mailing address:
  • Phone: 419-277-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTA LANGE CALDWELL
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 419-277-3569