Provider Demographics
NPI:1073902862
Name:CENTER FOR ASSESSMENT AND PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:CENTER FOR ASSESSMENT AND PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEALYNNE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BAUS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:419-602-3149
Mailing Address - Street 1:716 TRACHT MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1042
Mailing Address - Country:US
Mailing Address - Phone:419-357-1860
Mailing Address - Fax:
Practice Address - Street 1:1919 SANDUSKY MALL BLVD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-8912
Practice Address - Country:US
Practice Address - Phone:419-602-3149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5908251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2381042Medicaid
OH2381042Medicaid