Provider Demographics
NPI:1396802914
Name:JACKSON COUNTY PSYCHOLOGICAL SERVICES PA
Entity type:Organization
Organization Name:JACKSON COUNTY PSYCHOLOGICAL SERVICES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUTHIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-586-2311
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0728
Mailing Address - Country:US
Mailing Address - Phone:828-586-2311
Mailing Address - Fax:828-586-5450
Practice Address - Street 1:98D COPE CREEK RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-9508
Practice Address - Country:US
Practice Address - Phone:828-586-2311
Practice Address - Fax:828-586-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017UFOtherBCBS PROVIDER #
NC8302150Medicaid
NC6005078Medicaid
NC8300532Medicaid