Provider Demographics
NPI:1033662598
Name:ACCESS PSYCHOLOGICAL
Entity Type:Organization
Organization Name:ACCESS PSYCHOLOGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN OVERLOOP
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:906-228-8881
Mailing Address - Street 1:106 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4320
Mailing Address - Country:US
Mailing Address - Phone:906-228-8881
Mailing Address - Fax:
Practice Address - Street 1:106 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4320
Practice Address - Country:US
Practice Address - Phone:906-228-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010956441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty