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General NPI Number Information
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NPI Number | 1861288151
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL TESTING CENTER
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 200 W MONROE ST STE 307
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City | BLOOMINGTON
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State | IL
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Zip | 61701-3997
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Country | US
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Telephone | 309-909-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 1084 N POINTE DR
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City | NORMAL
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State | IL
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Zip | 61761-9751
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Country | US
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Telephone | 770-568-3896
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Fax | 770-568-3896
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOLOGIST
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Name | DR. CHRISTOPHER ALAN FUNK
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Credential | PSYD
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Telephone | 770-568-3896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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