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General NPI Number Information
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NPI Number | 1902304116
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 626 NEBRASKA AVE
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City | HOLTON
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State | KS
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Zip | 66436-1462
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Country | US
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Telephone | 785-362-7000
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Fax | 785-362-7100
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Provider Business Mailing Address
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Address Line | 626 NEBRASKA AVE
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City | HOLTON
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State | KS
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Zip | 66436-1462
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Country | US
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Telephone | 785-362-7000
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Fax | 785-362-7100
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA SNYDER
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Credential | LCP
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Telephone | 785-362-7000
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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 | 1431
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License Number State | KS
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