Provider Demographics
NPI:1396455796
Name:PSYCHTRUST COUNSELING AND PSYCHIATRY
Entity type:Organization
Organization Name:PSYCHTRUST COUNSELING AND PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-797-5522
Mailing Address - Street 1:3007 NOBLE CT
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:KY
Mailing Address - Zip Code:40385-9404
Mailing Address - Country:US
Mailing Address - Phone:859-797-5522
Mailing Address - Fax:
Practice Address - Street 1:3007 NOBLE CT
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:KY
Practice Address - Zip Code:40385-9404
Practice Address - Country:US
Practice Address - Phone:859-797-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty