Provider Demographics
NPI:1164588273
Name:KLAMATH PSYCHOLOGICAL ASSESSMENT SERVICES, INC.
Entity Type:Organization
Organization Name:KLAMATH PSYCHOLOGICAL ASSESSMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-331-3814
Mailing Address - Street 1:2025 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2025 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2062
Practice Address - Country:US
Practice Address - Phone:541-331-3814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR292325OtherOMAP
ORN35880OtherOREGON DEPT OF HUMAN SERV