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General NPI Number Information
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NPI Number | 1487636965
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Entity Type | Organization
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Legal Business Name | NORTH SHORE PSYCHOLOGICAL SERVICES LTD
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 355 W PROSPECT RD SUITE 124
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City | ASHTABULA
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State | OH
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Zip | 44004-5830
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Country | US
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Telephone | 440-992-1144
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Fax | 440-998-1996
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Provider Business Mailing Address
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Address Line | 355 W PROSPECT RD STE 124
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City | ASHTABULA
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State | OH
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Zip | 44004-5830
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Country | US
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Telephone | 440-992-1144
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Fax | 440-998-1996
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Authorized Official
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Title or Position | TREASURER
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Name | MR. DAVID L HAUSMAN
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Credential |
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Telephone | 440-992-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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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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