Psi Behavioral Health LLC

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

PSI BEHAVIORAL HEALTH LLC

Practice address

3890 Dunn Ave
Suite 1104
Jacksonville, FL 32218-6428

Phone

(904) 723-6049

NPI assigned

Sep 5, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ricky WallaceNPI 1538455142

Title

Ceo

Phone

(904) 723-6049

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Psi Behavioral Health LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Psi Behavioral Health, LLC

  • Community/Behavioral Health Agency
  • Jacksonville, FL
  • NPI 1154762284
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ricky Wallace

  • Social Worker
  • Jacksonville, FL
  • NPI 1538455142
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378339200000",
    "number": "1063847465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3890 DUNN AVE",
            "address_2": "SUITE 1104",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322186428",
            "telephone_number": "904-723-6049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3890 DUNN AVE",
            "address_2": "SUITE 1104",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322186428",
            "telephone_number": "904-723-6049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSI BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-05",
        "last_updated": "2013-09-05",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "RICKY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-723-6049",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Pruski-Long, RBT
• Karin Prussak, DNP
• Christopher Pryce II
• Taliya A Pryor, BS
• Joseph John Przybylowicz, CRNA
• Psi Behavioral Health, LLC
• Psychaccess and Recovery Solutions, LLC
• Psychiatric Solutions LLC
• Psychiatry by Mantilla-Rivas
• Psychoeducational Consultant Group

• Case Management Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Case Management Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.