Provider Demographics
NPI:1467402198
Name:PROFESSIONAL PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-866-1212
Mailing Address - Street 1:5577 AIRPORT HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7378
Mailing Address - Country:US
Mailing Address - Phone:419-866-1212
Mailing Address - Fax:419-866-4023
Practice Address - Street 1:5577 AIRPORT HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7378
Practice Address - Country:US
Practice Address - Phone:419-866-1212
Practice Address - Fax:419-866-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000503794OtherANTHEM BC
OH2005332Medicaid
OHDE8465OtherRR MEDICARE
OH291263OtherMHN GROUP NUMBER
OH44509020OtherAETNA GROUP NUMBER
OH2005332Medicaid
OH44509020OtherAETNA GROUP NUMBER