Provider Demographics
NPI:1174964662
Name:CLINICAL PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:CLINICAL PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KVALHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:937-750-0294
Mailing Address - Street 1:246 WILTSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2634
Mailing Address - Country:US
Mailing Address - Phone:937-546-7622
Mailing Address - Fax:937-401-0370
Practice Address - Street 1:1020 WOODMAN DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-1446
Practice Address - Country:US
Practice Address - Phone:937-750-0294
Practice Address - Fax:937-401-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty