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General NPI Number Information
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NPI Number | 1679907711
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Entity Type | Organization
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Legal Business Name | DIALECTIC PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 1011 N BYRNE RD
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City | TOLEDO
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State | OH
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Zip | 43607-2710
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Country | US
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Telephone | 419-788-7019
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8440
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City | TOLEDO
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State | OH
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Zip | 43623-0440
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Country | US
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Telephone | 419-885-0200
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Fax | 419-885-0203
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Authorized Official
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Title or Position | OWNER
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Name | DAVID K CONNELL
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Credential | PHD
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Telephone | 419-788-7019
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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 | 4675
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License Number State | OH
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