Provider Demographics
NPI:1386659266
Name:PSYCHOLOGICAL SYSTEMS, INC.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:IMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:740-369-3478
Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-1827
Mailing Address - Country:US
Mailing Address - Phone:740-369-3478
Mailing Address - Fax:740-881-0398
Practice Address - Street 1:244 PADDOCK CT
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1317
Practice Address - Country:US
Practice Address - Phone:740-369-3478
Practice Address - Fax:740-881-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG10250OtherMCBH
OH0836420Medicaid
OH0836420Medicaid
OH=========-00OtherBWC
OHG10250OtherMCBH