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General NPI Number Information
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NPI Number | 1275935033
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL ASSESSMENT SERVICES, LLC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 2380 N 124TH ST STE 101
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City | WAUWATOSA
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State | WI
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Zip | 53226-1071
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Country | US
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Telephone | 414-443-1773
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Fax | 414-443-1747
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Provider Business Mailing Address
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Address Line | 2380 N 124TH ST STE 101
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City | WAUWATOSA
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State | WI
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Zip | 53226-1071
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Country | US
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Telephone | 414-443-1773
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Fax | 414-443-1747
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Authorized Official
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Title or Position | PARTNER/LICENSED PSYCHOLOGIST
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Name | DR. KARYN L GUST-BREY
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Credential |
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Telephone | 414-443-1773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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