Provider Demographics
NPI:1508939372
Name:ASSOCIATED PSYCHOLOGICAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ASSOCIATED PSYCHOLOGICAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:920-457-9192
Mailing Address - Street 1:2808 KOHLER MEMORIAL DR, STE 1
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3166
Mailing Address - Country:US
Mailing Address - Phone:920-457-9192
Mailing Address - Fax:920-208-7060
Practice Address - Street 1:2808 KOHLER MEMORIAL DR, STE 1
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3166
Practice Address - Country:US
Practice Address - Phone:920-457-9192
Practice Address - Fax:920-208-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2563-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty