Provider Demographics
NPI:1194868794
Name:PSYCHIATRIC ASSOCIATES PA
Entity type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-242-6565
Mailing Address - Street 1:527 MILLS AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605
Mailing Address - Country:US
Mailing Address - Phone:864-242-6565
Mailing Address - Fax:864-242-3175
Practice Address - Street 1:527 MILLS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5602
Practice Address - Country:US
Practice Address - Phone:864-242-6565
Practice Address - Fax:864-242-3175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1272Medicare UPIN