NPIMap

Organization Active NPI

Phoenixpsychologicalservices Inc

  • Mental Health Counselor
  • North East, MD
National Provider Identifier
1265725733
Registry record updated Apr 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
R070399 Issued in MD
Legal business name
PHOENIXPSYCHOLOGICALSERVICES INC
Practice address
1930 Turkey Point Rd
North East, MD 21901-5452
Phone
(410) 287-4744
Fax
(443) 403-0364
NPI assigned
May 17, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2016

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

Authorized official

Name
Charla R Scheidle, PMHCNS-BCNPI 1053480913
Title
Owner/Ceo
Phone
(410) 287-4744

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X R070399 MD Primary

Addresses

Primary practice location

1930 Turkey Point Rd
North East, MD 21901-5452

Mailing address

1930 Turkey Point Rd
North East, MD 21901-5452
Phone (410) 287-4744

Other identifiers 1

IdentifierTypeStateIssuer
402020100MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110608000680 MD Part B Supplier - Clinic/Group Practice 7214114842 Receives reassigned benefits from 2 practitioners
Practice locations: North East, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460937600000",
    "number": "1265725733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 TURKEY POINT RD",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219015452",
            "telephone_number": "410-287-4744",
            "fax_number": "443-403-0364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 TURKEY POINT RD",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219015452",
            "telephone_number": "410-287-4744",
            "fax_number": "443-403-0364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIXPSYCHOLOGICALSERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-17",
        "last_updated": "2016-04-18",
        "status": "A",
        "authorized_official_last_name": "SCHEIDLE",
        "authorized_official_first_name": "CHARLA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "410-287-4744",
        "authorized_official_credential": "PMHCNS-BC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "R070399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402020100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North East, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.