Provider Demographics
NPI:1033559943
Name:SPENCER PSYCHOLOGY SERVICES, LLC
Entity type:Organization
Organization Name:SPENCER PSYCHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:715-533-0812
Mailing Address - Street 1:40154 US HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-9329
Mailing Address - Country:US
Mailing Address - Phone:715-533-0812
Mailing Address - Fax:888-823-3671
Practice Address - Street 1:40154 US HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-9329
Practice Address - Country:US
Practice Address - Phone:715-533-0812
Practice Address - Fax:888-823-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2573-057251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI620450011OtherMEDICARE PTAN