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General NPI Number Information
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NPI Number | 1386659266
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SYSTEMS, INC.
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 244 PADDOCK CT
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City | DELAWARE
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State | OH
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Zip | 43015-1317
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Country | US
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Telephone | 740-369-3478
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Fax | 740-881-0398
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Provider Business Mailing Address
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Address Line | PO BOX 1827
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City | POWELL
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State | OH
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Zip | 43065-1827
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Country | US
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Telephone | 740-369-3478
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Fax | 740-881-0398
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Authorized Official
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Title or Position | PRESIDENT/PSYCHOLOGIST
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Name | TERRY R IMAR
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Credential | M.A.
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Telephone | 740-369-3478
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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 | 1946
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License Number State | OH
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