Provider Demographics
NPI:1619276060
Name:UNI PSYCHOLOGICAL ASSESSMENT CLINIC
Entity Type:Organization
Organization Name:UNI PSYCHOLOGICAL ASSESSMENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EUSTIS
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-273-6297
Mailing Address - Street 1:PSYCH 1 CAMPUS ST
Mailing Address - Street 2:UNIVERSITY OF NORTHERN IOWA
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50614-0505
Mailing Address - Country:US
Mailing Address - Phone:319-273-6297
Mailing Address - Fax:319-273-3173
Practice Address - Street 1:PSYCH 1 CAMPUS ST
Practice Address - Street 2:UNIVERSITY OF NORTHERN IOWA
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0505
Practice Address - Country:US
Practice Address - Phone:319-273-6297
Practice Address - Fax:319-273-3173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTHERN IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)