Provider Demographics
NPI:1316212467
Name:PROFESSIONAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:PROFESSIONAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:OLESON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-621-3624
Mailing Address - Street 1:533 26TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2459
Mailing Address - Country:US
Mailing Address - Phone:801-621-3624
Mailing Address - Fax:
Practice Address - Street 1:533 26TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2465
Practice Address - Country:US
Practice Address - Phone:801-621-3624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT16788251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management