NPIMap

Organization Active NPI

Psychotherapeutic Services

  • Psychiatry Physician
  • Burlington, NC
National Provider Identifier
1104969997
Registry record updated Oct 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PSYCHOTHERAPEUTIC SERVICES
Practice address
2260 S Church St
Suite 304
Burlington, NC 21215
Phone
(336) 513-4229
Fax
(336) 513-4228
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2016

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

Authorized official

Name
Marcia Lynn Clendaniel
Title
Billing Manager
Phone
(410) 810-2465

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X NC Primary

Addresses

Primary practice location

2260 S Church St
Suite 304
Burlington, NC 21215

Mailing address

2260 S. Church St
Suite 304
Burlington, NC 21215
Phone (410) 778-9114

Other identifiers 2

IdentifierTypeStateIssuer
8300589IOtherNCMULTISYSTEMIC THERAPY
8300589MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Psychotherapeutic SVCS44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

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

View all 43

Locations

2260 S Church St
Ste 304
Burlington, NC 27215
Phone (336) 513-4229

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1104969997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 S. CHURCH ST",
            "address_2": "SUITE 304",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "21215",
            "telephone_number": "410-778-9114",
            "fax_number": "410-778-7988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2260 S CHURCH ST",
            "address_2": "SUITE 304",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "21215",
            "telephone_number": "336-513-4229",
            "fax_number": "336-513-4228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOTHERAPEUTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "CLENDANIEL",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "410-810-2465"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTISYSTEMIC THERAPY",
            "identifier": "8300589I",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300589",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; 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.