1114096385 NPI number — PSYCHIATRIC AND COUNSELING ASSOCIATES LLC

Table of content: (NPI 1114096385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114096385 NPI number — PSYCHIATRIC AND COUNSELING ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHIATRIC AND COUNSELING ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114096385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25101 CHAGRIN BLVD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-346-0392
Provider Business Mailing Address Fax Number:
216-456-8128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8400 W 110TH ST.
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66210-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-327-7505
Provider Business Practice Location Address Fax Number:
216-456-8128
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARDO
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CHIEF LEGAL OFFICER
Authorized Official Telephone Number:
425-279-8500

Provider Taxonomy Codes

  • Taxonomy code: 2084B0040X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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