Basic Information
| Provider Information | |||||||||
| NPI: | 1497908099 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCHOLOGICAL RESOURCE CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1218 N 4TH ST | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | TOMAHAWK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544872152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152242100 | ||||||||
| FaxNumber: | 7152242106 | ||||||||
| Practice Location | |||||||||
| Address1: | 1218 N 4TH ST | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | TOMAHAWK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544872152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152242100 | ||||||||
| FaxNumber: | 7152242106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2008 | ||||||||
| LastUpdateDate: | 02/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | ELCOATE | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7152242100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 2806 | WI | Y | Agencies | Community/Behavioral Health |
No ID Information.