Provider Demographics
NPI:1548672728
Name:PSYCHIATRIC AND PSYCHOLOGICAL SPECIALTIES
Entity type:Organization
Organization Name:PSYCHIATRIC AND PSYCHOLOGICAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YOJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEERAMASUNENI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:269-408-1688
Mailing Address - Street 1:415 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3100
Mailing Address - Country:US
Mailing Address - Phone:269-408-1688
Mailing Address - Fax:269-408-1692
Practice Address - Street 1:415 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3100
Practice Address - Country:US
Practice Address - Phone:269-408-1688
Practice Address - Fax:269-408-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty