Provider Demographics
NPI:1851501761
Name:PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES
Other - Org Name:PSYCH SVCS SW HI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:PERRA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:269-651-3902
Mailing Address - Street 1:103 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1819
Mailing Address - Country:US
Mailing Address - Phone:269-651-3902
Mailing Address - Fax:269-659-4874
Practice Address - Street 1:103 S 4TH ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1819
Practice Address - Country:US
Practice Address - Phone:269-651-3902
Practice Address - Fax:269-659-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty