| Organization Name: | COMMUNITY PSYCHOLOGICAL SERVICES OF WAUPUN LLC |
| NPI Number: | 1225138126 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT NORMAN DEYOUNG (PSYCHOLOGIST CO-OWNER) |
| Mailing Address: | 1208 S Watertown St Waupun |
| State: | WI US |
| Postal Code: | 539632309 |
| Phone Number: | 9203244358 |
| Fax Number: | |
| NPI Enumeration Date: | 09/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 1228 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |