Provider Demographics
NPI:1316169931
Name:H.S. PSYCHOLOGICAL SERVICES SC
Entity type:Organization
Organization Name:H.S. PSYCHOLOGICAL SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARASYMIW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:262-662-1116
Mailing Address - Street 1:W243S7630 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-8547
Mailing Address - Country:US
Mailing Address - Phone:262-662-1116
Mailing Address - Fax:262-662-1118
Practice Address - Street 1:W243S7630 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8547
Practice Address - Country:US
Practice Address - Phone:262-662-1116
Practice Address - Fax:262-662-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1625-057251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39192500Medicaid
WI39192500Medicaid