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General NPI Number Information
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NPI Number | 1013055086
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL & FAMILY CONSULTANTS
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 926 E JACKSON BLVD
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City | ELKHART
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State | IN
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Zip | 46516-4351
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Country | US
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Telephone | 574-522-6292
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Fax | 574-522-0481
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Provider Business Mailing Address
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Address Line | 926 E JACKSON BLVD
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City | ELKHART
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State | IN
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Zip | 46516-4351
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Country | US
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Telephone | 574-522-6292
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Fax | 574-522-0481
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ROSEANN M WOODKA
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Credential | PH. D.
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Telephone | 574-522-6292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 20041649A
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License Number State | IN
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