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General NPI Number Information
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NPI Number | 1205490844
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Entity Type | Organization
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Legal Business Name | ANGELA C. STANLEY, PSY.D. PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | W178N9912 RIVERCREST DR STE 108
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City | GERMANTOWN
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State | WI
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Zip | 53022-4662
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Country | US
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Telephone | 262-229-5581
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Fax |
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Provider Business Mailing Address
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Address Line | W178N9912 RIVERCREST DR STE 108
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City | GERMANTOWN
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State | WI
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Zip | 53022-4662
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Country | US
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Telephone | 262-229-5581
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGELA C STANLEY
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Credential | PSY.D.
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Telephone | 262-229-5581
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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 |
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License Number State |
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