Provider Demographics
NPI:1255519187
Name:RESERVE PSYCHOLOGICAL CONSULTANTS INC
Entity type:Organization
Organization Name:RESERVE PSYCHOLOGICAL CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMULA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MICHELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:330-929-1326
Mailing Address - Street 1:210 PORTAGE TRAIL EX W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1205
Mailing Address - Country:US
Mailing Address - Phone:330-929-1326
Mailing Address - Fax:
Practice Address - Street 1:210 PORTAGE TRAIL EX W
Practice Address - Street 2:SUITE 101
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1205
Practice Address - Country:US
Practice Address - Phone:330-929-1326
Practice Address - Fax:330-929-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty