Bowling Green State University

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6697 Issued in OH

Legal business name

BOWLING GREEN STATE UNIVERSITY

Practice address

822 E Merry Street Bowling Green State University
300 Psychology Building
Bowling Green, OH 43403

Phone

(419) 372-2540

Fax

(419) 372-2533

NPI assigned

Sep 2, 2010

Last updated

Jul 18, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Theresa Kelso

Title

Administrative Assistant

Phone

(419) 372-2540

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Psychological Services Center Other name

Tax ID family

Bgsu Speech and Hearing Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Bgsu Speech and Hearing Clinic

  • Speech-Language Pathologist
  • Bowling Green, OH
  • NPI 1316094022
  NPD tax ID
• Bgsu Speech and Hearing Clinic

  • Audiologist
  • Bowling Green, OH
  • NPI 1821110008
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carolyn J Tompsett, PH.D.

  • Clinical Psychologist
  • Bowling Green, OH
  • NPI 1689982522
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531872000000",
    "number": "1083921787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 E MERRY STREET BOWLING GREEN STATE UNIVERSITY",
            "address_2": "300 PSYCHOLOGY BUILDING",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434030232",
            "telephone_number": "419-372-2540",
            "fax_number": "419-372-2533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 E MERRY STREET BOWLING GREEN STATE UNIVERSITY",
            "address_2": "300 PSYCHOLOGY BUILDING",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "43403",
            "telephone_number": "419-372-2540",
            "fax_number": "419-372-2533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOWLING GREEN STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-02",
        "last_updated": "2018-07-18",
        "status": "A",
        "authorized_official_last_name": "KELSO",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "419-372-2540"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "6697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0747240",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychological Services Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Psychological Services Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Bowling Green State University
• Bowling Green State University (Student Health Service)
• Katherine Merie Bowman
• Amber N Boyer, LMT
• Karen Lee Brackenbury, M.A.,CCC-SLP

• Clinical Psychologist in Bowling Green, OH
• Providers in Bowling Green, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.