Provider Demographics
NPI:1043566854
Name:WILLIAMSON PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:WILLIAMSON PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVKUMAR
Authorized Official - Middle Name:LAKSHMINARAYAN
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-235-5556
Mailing Address - Street 1:215 LOGAN ST
Mailing Address - Street 2:SUITE 21
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3600
Mailing Address - Country:US
Mailing Address - Phone:304-235-5556
Mailing Address - Fax:304-235-5557
Practice Address - Street 1:215 LOGAN ST
Practice Address - Street 2:SUITE 21
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3600
Practice Address - Country:US
Practice Address - Phone:304-235-5556
Practice Address - Fax:304-235-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV187362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty