Provider Demographics
NPI:1255860854
Name:PROFESSIONAL SERVICES ASSOCIATES A PROFESSIONAL PSYCHOLOGICAL CORPORAT
Entity type:Organization
Organization Name:PROFESSIONAL SERVICES ASSOCIATES A PROFESSIONAL PSYCHOLOGICAL CORPORAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEYL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-341-8772
Mailing Address - Street 1:941 SPRING ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4546
Mailing Address - Country:US
Mailing Address - Phone:530-341-8772
Mailing Address - Fax:530-698-5241
Practice Address - Street 1:941 SPRING ST STE 5
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4546
Practice Address - Country:US
Practice Address - Phone:530-341-8772
Practice Address - Fax:530-698-5241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86919106H00000X
CA6138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty