Provider Demographics
NPI:1821495185
Name:INSIDE/OUT CLINICAL PSYCHOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:INSIDE/OUT CLINICAL PSYCHOLOGY SERVICES, LLC
Other - Org Name:INSIDE/OUT PSYCHOLOGICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-847-7924
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-0193
Mailing Address - Country:US
Mailing Address - Phone:608-847-7924
Mailing Address - Fax:608-847-7925
Practice Address - Street 1:102 W STATE ST
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1354
Practice Address - Country:US
Practice Address - Phone:608-847-7924
Practice Address - Fax:608-847-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2394-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty