Provider Demographics
NPI:1386134112
Name:PSYKE, LLC
Entity type:Organization
Organization Name:PSYKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKORA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-759-7328
Mailing Address - Street 1:41263 ROAD G
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328
Mailing Address - Country:US
Mailing Address - Phone:970-759-7328
Mailing Address - Fax:970-512-7848
Practice Address - Street 1:104 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328
Practice Address - Country:US
Practice Address - Phone:970-759-7328
Practice Address - Fax:970-512-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO881295Medicaid