Active NPI
Psychological Health Services, PC
- Clinical Psychologist
- Greensboro, NC
National Provider Identifier
1336191444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2642
- Legal business name
- PSYCHOLOGICAL HEALTH SERVICES, PC
- Practice address
- 2100 Fairfax Rd
Suite 208
Greensboro, NC 27407-3009 - Phone
- (336) 297-1981
- Fax
- (336) 297-1983
- NPI assigned
- May 17, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mary C Nemati, PH.D.
- Title
- President
- Phone
- (336) 297-1981
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2642 | NC | Primary |
Addresses
Primary practice location
2100 Fairfax Rd
Suite 208
Greensboro, NC 27407-3009
Mailing address
2100 Fairfax Rd
Suite 208
Greensboro, NC 27407-3009
Phone (336) 297-1981
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E3524 | Other | NC | MEDCOST PROVIDER NUMBER |
| 1336191444 | Medicaid | NC | |
| 6000189 | Medicaid | NC | |
| 045HP | Other | NC | BCBS PROVIDER NUMBER |
National Provider Directory
National Provider DirectoryLocations
2100 Fairfax Rd
Ste 208
Greensboro, NC 27407
Phone (336) 297-1981
204 Muirs Chapel Rd
Ste 105
Greensboro, NC 27410
Phone (336) 218-6420
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1274400000000",
"number": "1336191444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 FAIRFAX RD",
"address_2": "SUITE 208",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274073009",
"telephone_number": "336-297-1981",
"fax_number": "336-297-1983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 FAIRFAX RD",
"address_2": "SUITE 208",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274073009",
"telephone_number": "336-297-1981",
"fax_number": "336-297-1983"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PSYCHOLOGICAL HEALTH SERVICES, PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-17",
"last_updated": "2010-05-21",
"status": "A",
"authorized_official_last_name": "NEMATI",
"authorized_official_first_name": "MARY",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "336-297-1981",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PH.D."
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "2642",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST PROVIDER NUMBER",
"identifier": "E3524",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1336191444",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000189",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "045HP",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.