Provider Demographics
NPI:1497908099
Name:PSYCHOLOGICAL RESOURCE CENTER LLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL RESOURCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ELCOATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-224-2100
Mailing Address - Street 1:1218 N 4TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-2152
Mailing Address - Country:US
Mailing Address - Phone:715-224-2100
Mailing Address - Fax:715-224-2106
Practice Address - Street 1:1218 N 4TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-2152
Practice Address - Country:US
Practice Address - Phone:715-224-2100
Practice Address - Fax:715-224-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2806251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health