Healthcare Provider Details

I. General information

NPI: 1679735450
Provider Name (Legal Business Name): COMPREHENSIVE PSYCHOLOGICAL SERVICES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 COUNTY HOUSE LN
MARIETTA OH
45750-8015
US

IV. Provider business mailing address

845 COUNTY HOUSE LN
MARIETTA OH
45750-8015
US

V. Phone/Fax

Practice location:
  • Phone: 803-724-7924
  • Fax: 325-701-9199
Mailing address:
  • Phone: 803-724-7924
  • Fax: 325-701-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number37508
License Number StateTX

VIII. Authorized Official

Name: KEVIN R. SCHMUCKER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 803-724-7924