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General NPI Number Information
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NPI Number | 1154666956
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGY SERVICES OF OTTUMWA LLC
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 226 W MAIN ST STE 208
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City | OTTUMWA
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State | IA
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Zip | 52501-2503
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Country | US
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Telephone | 479-530-7003
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Fax |
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Provider Business Mailing Address
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Address Line | 226 W MAIN ST STE 208
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City | OTTUMWA
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State | IA
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Zip | 52501-2503
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Country | US
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Telephone | 479-530-7003
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN T MURRAY
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Credential | PHD
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Telephone | 479-530-7003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 001083
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License Number State | IA
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