Provider Demographics
NPI:1760483135
Name:UNIVERSITY PSYCHOLOGICAL SERVICES ASSOCIATION
Entity Type:Organization
Organization Name:UNIVERSITY PSYCHOLOGICAL SERVICES ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAPEARL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINFREY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:937-254-9210
Mailing Address - Street 1:PO BOX 341648
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45434
Mailing Address - Country:US
Mailing Address - Phone:937-254-9210
Mailing Address - Fax:937-254-9267
Practice Address - Street 1:9 N EDWIN C. MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402
Practice Address - Country:US
Practice Address - Phone:937-254-9210
Practice Address - Fax:937-254-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty