=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336205590
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEMORY & PSYCHOLOGICAL SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 10/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8180 BRECKSVILLE RD STE 115
-----------------------------------------------------
City | BRECKSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44141-1353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-546-0048
-----------------------------------------------------
Fax | 888-828-2326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8180 BRECKSVILLE RD STE 115
-----------------------------------------------------
City | BRECKSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44141-1353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-546-0048
-----------------------------------------------------
Fax | 888-828-2326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | CATHERINE WHEATLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 440-546-0048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6017
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | 6017
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------