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Contact Information

ELKHART PSYCHOLOGICAL SERVICES, LLC
6000 MONONA DR
SUITE 203
MONONA, WI53716-3931
 Phone: 608-223-9767
 Fax: 608-223-9767
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for ELKHART PSYCHOLOGICAL SERVICES, LLC

NPI # 1265554430
LBN Legal business name ELKHART PSYCHOLOGICAL SERVICES, LLC
Authorized official LAWRENCE MANDT - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/06/2007
Last updated 04/20/2008 - About 18 years ago
Identifiers
WI License # 1610
WI Medicaid 39088600
WI Other 1011078 PHYSICIANS PLUS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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