Community Psychological Services of Waupun LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

1228 Issued in WI

Legal business name

COMMUNITY PSYCHOLOGICAL SERVICES OF WAUPUN LLC

Practice address

1208 S Watertown St
Waupun, WI 53963-2309

Phone

(920) 324-4358

NPI assigned

Sep 22, 2006

Organization subpart

No

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

Authorized official

Name

Robert Norman Deyoung, PH DNPI 1972619229

Title

Psychologist Co-Owner

Phone

(920) 324-4358

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Norman Deyoung, PHD

  • Psychologist
  • Waupun, WI
  • NPI 1972619229
  NPD (past) Authorized official
• Richard Frank Eckerstorfer, LCSW

  • Clinical Social Worker
  • Waupun, WI
  • NPI 1831202696
  NPD (past)

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225138126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 S WATERTOWN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632309",
            "telephone_number": "920-324-4358",
            "fax_number": "920-324-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 S WATERTOWN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632309",
            "telephone_number": "920-324-4358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY PSYCHOLOGICAL SERVICES OF WAUPUN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEYOUNG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "NORMAN",
        "authorized_official_title_or_position": "PSYCHOLOGIST CO-OWNER",
        "authorized_official_telephone_number": "920-324-4358",
        "authorized_official_credential": "PH D"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "1228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42127800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tai M Chan, O.D.
• Teresa J Chouinard, APNP
• Christian Home and Rehabilitation Center, Inc.
• Christian Home Care and Rehab Center LLC
• City of Waupun
• Consultants Laboratory of Wisconsin, LLC
• Consultants Laboratory of Wisconsin, LLC
• Carole Marie Cronin, R.PH.
• Melissa Jean Czerwinski, FNP-BC
• Jennifer A Davis

• Mental Health Clinic/Center (Including Community Mental Health Center) in Waupun, WI
• Providers in Waupun, WI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.