Provider Demographics
NPI:1467459842
Name:NORTHERN OHIO PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHERN OHIO PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL CHILD PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEALYNNE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BAUS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:419-624-1277
Mailing Address - Street 1:1717 E PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7919
Mailing Address - Country:US
Mailing Address - Phone:419-624-1277
Mailing Address - Fax:419-624-1274
Practice Address - Street 1:1717 E PERKINS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7919
Practice Address - Country:US
Practice Address - Phone:419-624-1277
Practice Address - Fax:419-624-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5908103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty