Provider Demographics
NPI:1861102105
Name:REAL PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:REAL PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:614-427-3205
Mailing Address - Street 1:4770 INDIANOLA AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1862
Mailing Address - Country:US
Mailing Address - Phone:614-427-3205
Mailing Address - Fax:866-376-9053
Practice Address - Street 1:4770 INDIANOLA AVE STE 111
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1862
Practice Address - Country:US
Practice Address - Phone:614-427-3205
Practice Address - Fax:866-376-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty