Basic Information
| Provider Information | |||||||||
| NPI: | 1982845517 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UIUC PSYCHOLOGICAL SERVICES CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 E GREEN ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618205723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173330041 | ||||||||
| FaxNumber: | 2173330064 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 E GREEN ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618205723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173330041 | ||||||||
| FaxNumber: | 2173330064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2009 | ||||||||
| LastUpdateDate: | 03/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | SHPUNGIN | ||||||||
| AuthorizedOfficialFirstName: | ELAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2173330041 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.