Provider Demographics
NPI:1639293012
Name:PSYCHOLOGICAL RESOURCES LTD
Entity Type:Organization
Organization Name:PSYCHOLOGICAL RESOURCES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-352-6666
Mailing Address - Street 1:970 W WOOSTER ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2643
Mailing Address - Country:US
Mailing Address - Phone:419-352-6666
Mailing Address - Fax:419-353-1117
Practice Address - Street 1:4841 MONROE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4385
Practice Address - Country:US
Practice Address - Phone:419-475-2535
Practice Address - Fax:419-475-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9241472Medicare PIN
OH9241471Medicare PIN