Provider Demographics
NPI:1972723971
Name:OHIO UNIVERSITY PSYCHOLOGY AND SOCIAL WORK CLINIC
Entity Type:Organization
Organization Name:OHIO UNIVERSITY PSYCHOLOGY AND SOCIAL WORK CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL TRAINING
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUHR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:740-593-0902
Mailing Address - Street 1:1 OHIO UNIVERSITY
Mailing Address - Street 2:DEPT OF PSYCHOLOGY, PORTER HALL ROOM 002
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 OHIO UNIVERSITY
Practice Address - Street 2:DEPT OF PSYCHOLOGY, PORTER HALL ROOM 002
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2942
Practice Address - Country:US
Practice Address - Phone:740-597-1251
Practice Address - Fax:740-593-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty