Provider Demographics
NPI:1275935033
Name:PSYCHOLOGICAL ASSESSMENT SERVICES, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSESSMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUST-BREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-443-1773
Mailing Address - Street 1:2380 N 124TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1071
Mailing Address - Country:US
Mailing Address - Phone:414-443-1773
Mailing Address - Fax:414-443-1747
Practice Address - Street 1:2380 N 124TH ST STE 101
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1071
Practice Address - Country:US
Practice Address - Phone:414-443-1773
Practice Address - Fax:414-443-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1619072170Medicaid
WI1861622524Medicaid