NPIMap

Organization Active NPI

Psychotherpeutic Services, Inc

  • Psychiatry Physician
  • Burlington, NC
National Provider Identifier
1811030612
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PSYCHOTHERPEUTIC SERVICES, INC
Practice address
405 Rudd St
Burlington, NC 27217-2957
Phone
(336) 513-4229
Fax
(336) 513-4228
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Randall Cooper, CPA
Title
Cfo
Phone
(410) 778-9114

Specialties & licenses 1

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

Addresses

Primary practice location

405 Rudd St
Burlington, NC 27217-2957

Mailing address

PO Box 690
Chestertown, MD 21620-0690
Phone (410) 778-9114

Other identifiers 2

IdentifierTypeStateIssuer
8300589MedicaidNC
8300589BOtherNCCOMMUNITY SUPPORT SERVICE

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811030612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216200690",
            "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": "405 RUDD ST",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272172957",
            "telephone_number": "336-513-4229",
            "fax_number": "336-513-4228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOTHERPEUTIC SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "410-778-9114",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300589",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY SUPPORT SERVICE",
            "identifier": "8300589B",
            "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 Aug 22, 2020; 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.