=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629587126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORLEANS PSYCHOLOGICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 W OLENTANGY STREET
-----------------------------------------------------
City | POWELL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-436-4457
-----------------------------------------------------
Fax | 614-407-9648
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 W OLENTANGY ST
-----------------------------------------------------
City | POWELL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43065-8717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-436-4457
-----------------------------------------------------
Fax | 614-407-9648
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. TIMOTHY M LUIS
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 614-436-4457
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6721
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------