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General NPI Number Information
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NPI Number | 1992920300
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL CONSULATNTS S.C.
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 130 E. WALUNT STREET 604
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City | GREEN BAY
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State | WI
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Zip | 54301
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Country | US
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Telephone | 920-437-3854
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Fax | 920-437-7488
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Provider Business Mailing Address
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Address Line | 130 E. WALUNT STREET 604
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City | GREEN BAY
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State | WI
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Zip | 54301
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Country | US
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Telephone | 920-437-3854
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Fax | 920-437-7488
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. URSULA BERTRAND
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Credential | PH.D.
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Telephone | 920-437-3854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1042
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License Number State | WI
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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 | 2463-057
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License Number State | WI
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