Organization Name: | HEALTHCARE PSYCHOLOGY CONSULTANTS LLC |
NPI Number: | 1063532380 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL LUTHER JORN (CLINICAL PSYCHOLOGIST SOLE OWNER) |
Mailing Address: | 4447 N Oakland Ave Shorewood |
State: | WI US |
Postal Code: | 53211 |
Phone Number: | 4144314322 |
Fax Number: | 4144314323 |
NPI Enumeration Date: | 03/30/2007 |
NPI Last Update Date: | 12/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1912 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |