Provider Demographics
NPI:1922664671
Name:PSYCHOLOGICAL SERVCIES LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVCIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PH.D., LPC
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:814-312-3459
Mailing Address - Street 1:835 SCHOOLHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16613-7514
Mailing Address - Country:US
Mailing Address - Phone:814-312-3459
Mailing Address - Fax:
Practice Address - Street 1:615 HOWARD AVE STE 207
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4813
Practice Address - Country:US
Practice Address - Phone:814-312-3459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty