Provider Demographics
NPI:1932433463
Name:SOUTHSIDE PSYCHOLOGY SERVICES PC
Entity Type:Organization
Organization Name:SOUTHSIDE PSYCHOLOGY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-484-0611
Mailing Address - Street 1:PO BOX 5803
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0803
Mailing Address - Country:US
Mailing Address - Phone:541-484-0611
Mailing Address - Fax:541-431-7006
Practice Address - Street 1:5 E 24TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2907
Practice Address - Country:US
Practice Address - Phone:541-484-0611
Practice Address - Fax:541-431-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty