Psyclinc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3163 Issued in NC

Legal business name

PSYCLINC

Practice address

518 S Aspen St
Lincolnton, NC 28092-2735

Phone

(704) 530-0850

Fax

(704) 735-9810

NPI assigned

May 7, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Mary Reavis, PH.D.NPI 1659320265

Title

Owner of Business

Phone

(704) 530-0850

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Rebecca Reavis PhD Doing business as

Tax ID family

Psyclinc2 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.

• Psyclinc

  • Community/Behavioral Health Agency
  • Lincolnton, NC
  • NPI 1235538901
  NPD tax ID

Locations

Practitioners 1

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

• Mary R Reavis, PH.D.

  • Clinical Psychologist
  • Lincolnton, NC
  • NPI 1659320265
  NPD (past) Authorized official

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

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358812800000",
    "number": "1356517536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 S ASPEN ST",
            "city": "LINCOLNTON",
            "state": "NC",
            "postal_code": "280922735",
            "telephone_number": "704-530-0850",
            "fax_number": "704-735-9810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 S ASPEN ST",
            "city": "LINCOLNTON",
            "state": "NC",
            "postal_code": "280922735",
            "telephone_number": "704-530-0850",
            "fax_number": "704-735-9810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCLINC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-07",
        "last_updated": "2013-01-22",
        "status": "A",
        "authorized_official_last_name": "REAVIS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER OF BUSINESS",
        "authorized_official_telephone_number": "704-530-0850",
        "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": "3163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "3163",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000865",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006696",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rebecca Reavis PhD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jenesia Renee Pope, BT
• Stephanie Ann Porter, PHD, LPCS, CCS, MAC
• Allison Marie Prinz, MD
• Prowellness Family Chiropractic Inc
• Psyclinc
• Lavanya Sireesha Putchala, DDS
• R Keith Dedmond DDS PA
• R. Gary Hensley, D.M.D., P.a.
• Toma Radut, MD
• Christopher J Ramke, DMD

• Clinical Psychologist in Lincolnton, NC
• Providers in Lincolnton, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.