Provider Demographics
NPI:1427178227
Name:HUTTER & SEELEY PSYCHOLOGICAL SERVICES, P.C.
Entity type:Organization
Organization Name:HUTTER & SEELEY PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP. SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-601-2968
Mailing Address - Street 1:711 MEDFORD CENTER
Mailing Address - Street 2:#168
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-601-2968
Mailing Address - Fax:541-488-5011
Practice Address - Street 1:711 MEDFORD CENTER
Practice Address - Street 2:#168
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-601-2968
Practice Address - Fax:541-488-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1573103T00000X, 103TC0700X
OR1563103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR146295Medicare PIN