Provider Demographics
NPI:1649001736
Name:PSYCHIATRIC SOLUTIONS LLC
Entity type:Organization
Organization Name:PSYCHIATRIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE ABIGAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALCOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C, PMHNP-BC
Authorized Official - Phone:602-568-9556
Mailing Address - Street 1:19801 N 59TH AVE UNIT 10116
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-5006
Mailing Address - Country:US
Mailing Address - Phone:623-308-2472
Mailing Address - Fax:
Practice Address - Street 1:10000 N 31ST AVE STE C100-138
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1395
Practice Address - Country:US
Practice Address - Phone:623-308-2472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty