Organization
DAKOTA PROFESSIONAL CORP
Active
Other names
Professional Psychological Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACY L FAHLSING PHD (CEO OF PROFESSIONAL PSYCH ASSOC)
(419) 999-2024
Entity
Organization
Contact information
Practice address
3745 SHAWNEE RD STE 105, LIMA, OH 45806-1662
(419) 999-2024
(419) 999-2024
Mailing address
3611 S DIXIE HWY, LIMA, OH 45804
(419) 999-2024
(419) 999-2024
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5830
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47586656100
BWC RISK #1313922
OH
Enumeration date
05/19/2006
Last updated
11/19/2019
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