Provider Demographics
NPI:1104563600
Name:ROYAL THERAPEUTICS PSYCH LTD.
Entity type:Organization
Organization Name:ROYAL THERAPEUTICS PSYCH LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP, PMHNP-BC
Authorized Official - Phone:513-416-3206
Mailing Address - Street 1:222 QUAIL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-4608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:45381-1191
Practice Address - Country:US
Practice Address - Phone:513-416-3206
Practice Address - Fax:517-210-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1710648480Medicaid