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General NPI Number Information
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NPI Number | 1972723971
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Entity Type | Organization
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Legal Business Name | OHIO UNIVERSITY PSYCHOLOGY AND SOCIAL WORK CLINIC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/24/2017
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Provider Practice Location Address
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Address Line | 1 OHIO UNIVERSITY DEPT OF PSYCHOLOGY, PORTER HALL ROOM 002
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City | ATHENS
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State | OH
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Zip | 45701-2942
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Country | US
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Telephone | 740-597-1251
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Fax | 740-593-4790
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Provider Business Mailing Address
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Address Line | 1 OHIO UNIVERSITY DEPT OF PSYCHOLOGY, PORTER HALL ROOM 002
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City | ATHENS
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State | OH
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Zip | 45701-2942
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL TRAINING
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Name | JULIE A SUHR
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Credential | PHD
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Telephone | 740-593-0902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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