NPIMap

Organization Active NPI

Bowling Green State University

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bowling Green, OH
National Provider Identifier
1366409690
Registry record updated Jun 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
BOWLING GREEN STATE UNIVERSITY
Practice address
Psychological Services Center
Suite 300 Psychology Dept. Bowling Green State Univ
Bowling Green, OH 43403
Phone
(419) 372-2540
Fax
(419) 372-2533
NPI assigned
Apr 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2018

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

Authorized official

Name
Theresa K Kelso
Title
Administrative Assistant
Phone
(419) 372-2540

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

Psychological Services Center
Suite 300 Psychology Dept. Bowling Green State Univ
Bowling Green, OH 43403

Mailing address

Psychological Services Center
Suite 300 Psychology Dept. Bowling Green State Univ
Bowling Green, OH 43403-0001
Phone (419) 372-2540

Other identifiers 1

IdentifierTypeStateIssuer
0747240MedicaidOH

Other names 1

  • Bowling Green State University Other name

National Provider Directory

National Provider Directory

Locations

822 E Merry
Bowling Green, OH 43403

Psychological Services Ctr
Bowling Green, OH 43403
Phone (419) 372-2974

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529280000000",
    "number": "1366409690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PSYCHOLOGICAL SERVICES CENTER",
            "address_2": "SUITE 300 PSYCHOLOGY DEPT. BOWLING GREEN STATE UNIV",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434030001",
            "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": "PSYCHOLOGICAL SERVICES CENTER",
            "address_2": "SUITE 300 PSYCHOLOGY DEPT. BOWLING GREEN STATE UNIV",
            "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": "2006-04-28",
        "last_updated": "2018-06-18",
        "status": "A",
        "authorized_official_last_name": "KELSO",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "419-372-2540"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0747240",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bowling Green State University",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Bowling Green State University",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bowling Green, OH

Sources for this page

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