Provider Demographics
NPI:1972155299
Name:WASSON PSYCHOLOGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:WASSON PSYCHOLOGICAL ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-246-1975
Mailing Address - Street 1:8700 INDIAN CREEK PKWY STE 270
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8700 INDIAN CREEK PKWY STE 270
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1527
Practice Address - Country:US
Practice Address - Phone:908-246-1975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)