| Organization Name: | PSYCHOLOGICAL SERVICE CENTER, LLC |
| NPI Number: | 1194964353 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIEL J LANE (CHIEF PSYCHOLOGIST) |
| Mailing Address: | 1135 Makawao Ave Makawao |
| State: | HI US |
| Postal Code: | 967687403 |
| Phone Number: | 8082809457 |
| Fax Number: | 8085720311 |
| NPI Enumeration Date: | 02/11/2009 |
| NPI Last Update Date: | 02/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |