NPIMap

Organization Active NPI

Southeast Psych Services LLC

Doing business as Integrated Psych Solutions

  • Psychologist
  • Ellicott City, MD
National Provider Identifier
1871188771
Registry record updated Aug 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
SOUTHEAST PSYCH SERVICES LLC
Doing business as
Integrated Psych Solutions
Practice address
3355 Saint Johns LN Ste F
Ellicott City, MD 21042-2600
Phone
(706) 204-1493
Fax
(855) 264-6670
NPI assigned
Mar 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2026

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

Authorized official

Name
Davis Debrady
Title
Director
Phone
(706) 204-1493

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

3355 Saint Johns LN Ste F
Ellicott City, MD 21042-2600

Mailing address

1265 Interstate Pkwy Ste B
Augusta, GA 30909-6481
Phone (706) 204-1366

Other practice location 1

500 Marquette Ave NW Ste 1200
Albuquerque, NM 87102-5312
Phone (706) 204-1493

Other practice location 2

3636 N Central Ave Ste 710
Phoenix, AZ 85012-1936
Phone (706) 204-1493

Other practice location 3

561 Fieldcrest Dr
The Villages, FL 32162-4600
Phone (523) 097-4653

Other names 1

  • Integrated Psych Solutions Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210428001401 FL Part B Supplier - Clinic/Group Practice 8820406093 Receives reassigned benefits from 22 practitioners
Practice locations: Miami, FL

National Provider Directory

National Provider Directory

Locations

3636 N Central Ave
Ste 710
Phoenix, AZ 85012
Phone (706) 204-1493

561 Fieldcrest Dr
The Villages, FL 32162
Phone (352) 309-7465

207 Hudson Trce
#100
Augusta, GA 30907

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1614729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786579200000",
    "number": "1871188771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 INTERSTATE PKWY STE B",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096481",
            "telephone_number": "706-204-1366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 SAINT JOHNS LN STE F",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210422600",
            "telephone_number": "706-204-1493",
            "fax_number": "855-264-6670"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Marquette Ave NW Ste 1200",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871025312",
            "country_code": "US",
            "telephone_number": "706-204-1493",
            "fax_number": "855-264-6670",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3636 N Central Ave Ste 710",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850121936",
            "country_code": "US",
            "telephone_number": "706-204-1493",
            "fax_number": "855-264-6670",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "561 Fieldcrest Dr",
            "address_purpose": "LOCATION",
            "city": "The Villages",
            "state": "FL",
            "postal_code": "321624600",
            "country_code": "US",
            "telephone_number": "523-097-4653",
            "fax_number": "855-264-6670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEAST PSYCH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-03",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A",
        "authorized_official_last_name": "DEBRADY",
        "authorized_official_first_name": "DAVIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "706-204-1493"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Psych Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; 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.