PSYCHOLOGICAL SERVICE ASSOCIATES, INC (NPI# 1558441063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558441063 |
| Entity Type | Organization |
| Organization Name | PSYCHOLOGICAL SERVICE ASSOCIATES, INC |
| Practice Address |
3421 E State Blvd Fort Wayne IN 46805-4830 |
| Practice Telephone | 2604828427 |
| Practice Fax Number | 2604828429 |
| Mailing Telephone | 2604828427 |
| Mailing Fax Number | 2604828429 |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JERE W LEIB (PRESIDENT) |
| Authorized Official Telephone | 2604828427 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 103TA0700X |
Psychologist Specialization: Adult Development & Aging |
========= | IN | Behavioral Health & Social Service Providers |
| X | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
========= | IN | Behavioral Health & Social Service Providers |
| X | 103TC0700X |
Psychologist Specialization: Clinical |
========= | IN | Behavioral Health & Social Service Providers |
| X | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
========= | IN | Behavioral Health & Social Service Providers |
| X | 103TF0000X |
Psychologist Specialization: Family |
========= | IN | Behavioral Health & Social Service Providers |
| X | 103TF0200X |
Psychologist Specialization: Forensic |
========= | IN | Behavioral Health & Social Service Providers |
| X | 103TH0100X |
Psychologist Specialization: Health Service |
========= | IN | Behavioral Health & Social Service Providers |
| X | 103T00000X | Psychologist | ========= | IN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | BCBS GROUP | 000000176183 | 01 |
| Street Address |
3421 E STATE BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-4830 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457350506 | Jere W Leib | Psychologist | 3421 E State Blvd, Fort Wayne, IN 46805-4830 | 2005-07-20 |
| 1992912471 | Nancy Scrogham Gerow | Marriage & Family Therapist | 3421 E State Blvd, Fort Wayne, IN 46805-4830 | 2007-05-16 |
| 1932108982 | Rodney E Timbrook | Psychologist | 3421 E State Blvd, Fort Wayne, IN 46805-4830 | 2005-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| Taxonomy Code | 103TA0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Adult Development & Aging |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093126765 | Daniel Tobias Kachur | Psychologist | 15 North Franklin Street, Suite 230, Valparaiso, IN 46383 | 2014-05-15 |
| 1083644546 | Ronald M Westrate | Psychologist | 1380e County Line Rd, Indianapolis, IN 46227-0962 | 2006-07-03 |
| 1407474257 | William Lawrence Heard | Psychologist | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2020-07-08 |
| 1023671930 | Leah Exmeyer | Psychologist | 1558 E Boulevard Ste A, Kokomo, IN 46902-2479 | 2019-04-16 |
| 1912215260 | Ginger B Lines | Psychologist | 17840 Cumberland Rd, Noblesville, IN 46060-5409 | 2010-09-21 |
| 1750599981 | Great Lakes Institute for Neuropsychology & Behavioral Health | Psychologist | 494 S Emerson Ave, Suite C, Greenwood, IN 46143-1912 | 2007-05-20 |
| 1598742728 | Melissa M Umali | Psychologist | 1808 Sherman Dr, Princeton, IN 47670-1043 | 2005-12-29 |
| 1144228123 | Gary Frances Meunier | Psychologist | 1106 Meridian St, Suite 344, Anderson, IN 46016-2776 | 2005-07-13 |
| City | FORT WAYNE |
| Zip Code | 46805 |
Please comment or provide details below to improve the information on PSYCHOLOGICAL SERVICE ASSOCIATES, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.