Provider Demographics
NPI:1336205590
Name:MEMORY & PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:MEMORY & PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-546-0048
Mailing Address - Street 1:8180 BRECKSVILLE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1353
Mailing Address - Country:US
Mailing Address - Phone:440-546-0048
Mailing Address - Fax:888-828-2326
Practice Address - Street 1:8180 BRECKSVILLE RD STE 115
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1353
Practice Address - Country:US
Practice Address - Phone:440-546-0048
Practice Address - Fax:888-828-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6017103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPS9359841Medicare ID - Type UnspecifiedGROUP NUMBER