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NPI Code Detail

MEDICARE: OHIO UNIVERSITY PSYCHOLOGY AND SOCIAL WORK CLINIC

MEDICARE: OHIO UNIVERSITY PSYCHOLOGY AND SOCIAL WORK CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical Neuropsychologist
2103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1972723971
Entity Type Code : Organization
Provider Name (Legal Business Name) : OHIO UNIVERSITY PSYCHOLOGY AND SOCIAL WORK CLINIC
Provider Business Mailing Address
First Line : 1 OHIO UNIVERSITY
Second Line : DEPT OF PSYCHOLOGY, PORTER HALL ROOM 002
City : ATHENS
State : OH
Zip : 45701-2942
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 OHIO UNIVERSITY
Second Line : DEPT OF PSYCHOLOGY, PORTER HALL ROOM 002
City : ATHENS
State : OH
Zip : 45701-2942
Country : US
Telephone Number : 740-597-1251
Fax Number : 740-593-4790
Authorized Official
Title or Position : DIRECTOR OF CLINICAL TRAINING
Name : JULIE A SUHR
Credential : PHD
Telephone Number : 740-593-0902
Provider Enumeration Date : 05/01/2007
Last Update Date : 08/24/2017

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Directions to “OHIO UNIVERSITY PSYCHOLOGY AND SOCIAL WORK CLINIC ” Practice Location

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