| Professional Psychological Associates | |
|
3745 Shawnee Rd Ste 105 Lima OH 45806-1662 | |
| (419) 999-2024 | |
| (419) 999-2024 |
| Full Name | Professional Psychological Associates |
|---|---|
| Speciality | Psychologist |
| Location | 3745 Shawnee Rd Ste 105, Lima, Ohio |
| Authorized Official Name and Position | Stacy L Fahlsing (CEO OF PROFESSIONAL PSYCH ASSOC) |
| Authorized Official Contact | 4199992024 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Psychological Associates 3611 S Dixie Hwy Lima OH 45804 Ph: (419) 999-2024 | Professional Psychological Associates 3745 Shawnee Rd Ste 105 Lima OH 45806-1662 Ph: (419) 999-2024 |
| NPI Number | 1083667828 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 11/19/2019 |
| Medicare PECOS PAC ID | 6800810904 |
|---|---|
| Medicare Enrollment ID | O20060117000171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083667828 | NPI | - | NPPES |
| 47586656100 | Other | OH | BWC RISK #1313922 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 5830 (Ohio) | Primary |
| Provider Name | Kristine M Thackrey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497819916 PECOS PAC ID: 8426152513 Enrollment ID: I20070329000374 |
| Provider Name | Stacy L Fahlsing |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457416158 PECOS PAC ID: 5890719991 Enrollment ID: I20120130000213 |
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