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General NPI Number Information
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NPI Number | 1467111492
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Entity Type | Organization
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Legal Business Name | FOUR DIRECTIONS PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 12/17/2021
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 3454 OAK ALLEY CT STE 200
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City | TOLEDO
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State | OH
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Zip | 43606-1370
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Country | US
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Telephone | 419-460-0413
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Fax | 844-443-0075
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Provider Business Mailing Address
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Address Line | 3454 OAK ALLEY CT STE 200
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City | TOLEDO
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State | OH
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Zip | 43606-1370
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Country | US
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Telephone | 141-946-0041
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA JEAN LEWIS
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Credential | PSYCHOLOGIST
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Telephone | 419-460-0413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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