Organization
PSYCHOLOGICAL SERVICE ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERE W LEIB PH.D. (PRESIDENT)
(260) 482-8427
Entity
Organization
Contact information
Practice address
3421 E STATE BLVD, FORT WAYNE, IN 46805-4830
(260) 482-8427
(260) 482-8429
Mailing address
3421 E STATE BLVD, FORT WAYNE, IN 46805-4830
(260) 482-8427
(260) 482-8429
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
IN
103TA0700X
Adult Development & Aging Psychologist
—
IN
103TB0200X
Cognitive & Behavioral Psychologist
—
IN
103TC0700X
Clinical Psychologist
—
IN
103TC2200X
Clinical Child & Adolescent Psychologist
—
IN
103TF0000X
Family Psychologist
—
IN
103TF0200X
Forensic Psychologist
—
IN
103TH0100X
Health Service Psychologist
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000176183
BCBS GROUP
IN
Enumeration date
10/17/2006
Last updated
09/11/2025
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