| Organization Name: | ELKHART PSYCHOLOGICAL SERVICES, LLC |
| NPI Number: | 1265554430 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAWRENCE MANDT (OWNER) |
| Mailing Address: | 6000 Monona Dr Suite 203 Monona |
| State: | WI US |
| Postal Code: | 537163931 |
| Phone Number: | 6082239767 |
| Fax Number: | 6082239767 |
| NPI Enumeration Date: | 04/06/2007 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1610 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |