Provider Demographics
NPI:1134392244
Name:EXCEPTIONAL PSYCHOLOGICAL SERVICES INC.
Entity type:Organization
Organization Name:EXCEPTIONAL PSYCHOLOGICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JORETHIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-391-4970
Mailing Address - Street 1:2125 SUPERIOR AVE E STE 9
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2101
Mailing Address - Country:US
Mailing Address - Phone:216-391-0470
Mailing Address - Fax:216-664-0582
Practice Address - Street 1:2125 SUPERIOR AVE E STE 9
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2101
Practice Address - Country:US
Practice Address - Phone:216-391-0470
Practice Address - Fax:216-664-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5755103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty