| Bowling Green State University | |
|
822 E Merry Street Bowling Green State University 300 Psychology Building Bowling Green OH 43403 | |
| (419) 372-2540 | |
| (419) 372-2533 |
| Full Name | Bowling Green State University |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 822 E Merry Street Bowling Green State University, Bowling Green, Ohio |
| Authorized Official Name and Position | Theresa Kelso (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Contact | 4193722540 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bowling Green State University 822 E Merry Street Bowling Green State University 300 Psychology Building Bowling Green OH 43403-0232 Ph: (419) 372-2540 | Bowling Green State University 822 E Merry Street Bowling Green State University 300 Psychology Building Bowling Green OH 43403 Ph: (419) 372-2540 |
| NPI Number | 1083921787 |
|---|---|
| Provider Enumeration Date | 09/02/2010 |
| Last Update Date | 07/18/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083921787 | NPI | - | NPPES |
| 0747240 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6697 (Ohio) | Primary |
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