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General NPI Number Information
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NPI Number | 1578913356
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Entity Type | Organization
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Legal Business Name | WESTERN OHIO PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 110 E POPLAR ST STE. 7
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City | SIDNEY
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State | OH
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Zip | 45365-2985
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Country | US
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Telephone | 937-638-5210
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Fax |
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Provider Business Mailing Address
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Address Line | 110 E POPLAR ST STE. 7
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City | SIDNEY
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State | OH
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Zip | 45365-2985
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Country | US
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Telephone | 937-638-5210
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Fax |
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Authorized Official
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Title or Position | PSYD
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Name | JACQUELINE ALLEN
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Credential |
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Telephone | 973-638-5210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7027
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License Number State | OH
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