Provider Demographics
NPI:1386763829
Name:BATTEN PSYCHOLOGICAL & FAMILY SERVICES
Entity type:Organization
Organization Name:BATTEN PSYCHOLOGICAL & FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:BATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-748-9070
Mailing Address - Street 1:2910A BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3077
Mailing Address - Country:US
Mailing Address - Phone:336-748-9070
Mailing Address - Fax:336-773-0332
Practice Address - Street 1:2910A BRIARCLIFF RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3077
Practice Address - Country:US
Practice Address - Phone:336-748-9070
Practice Address - Fax:336-773-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1156103TC0700X
NCCOOO9171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013HYOtherBLUE CROSS BLUE SHIELD