Provider Demographics
NPI: | 1497908099 |
---|---|
Name: | PSYCHOLOGICAL RESOURCE CENTER LLC |
Entity Type: | Organization |
Organization Name: | PSYCHOLOGICAL RESOURCE CENTER LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAURA |
Authorized Official - Middle Name: | ANNE |
Authorized Official - Last Name: | ELCOATE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 715-224-2100 |
Mailing Address - Street 1: | 1218 N 4TH ST |
Mailing Address - Street 2: | SUITE 108 |
Mailing Address - City: | TOMAHAWK |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 54487-2152 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 715-224-2100 |
Mailing Address - Fax: | 715-224-2106 |
Practice Address - Street 1: | 1218 N 4TH ST |
Practice Address - Street 2: | SUITE 108 |
Practice Address - City: | TOMAHAWK |
Practice Address - State: | WI |
Practice Address - Zip Code: | 54487-2152 |
Practice Address - Country: | US |
Practice Address - Phone: | 715-224-2100 |
Practice Address - Fax: | 715-224-2106 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-10-28 |
Last Update Date: | 2009-02-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 2806 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |