Healthcare Provider Details

I. General information

NPI: 1467111492
Provider Name (Legal Business Name): FOUR DIRECTIONS PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 OAK ALLEY CT STE 200
TOLEDO OH
43606-1370
US

IV. Provider business mailing address

3454 OAK ALLEY CT STE 200
TOLEDO OH
43606-1370
US

V. Phone/Fax

Practice location:
  • Phone: 419-460-0413
  • Fax: 844-443-0075
Mailing address:
  • Phone: 141-946-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LAURA JEAN LEWIS
Title or Position: OWNER
Credential: PSYCHOLOGIST
Phone: 419-460-0413