Provider Demographics
NPI:1073634341
Name:PSYCHIATRIC CENTER INC.
Entity Type:Organization
Organization Name:PSYCHIATRIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:VALLABH
Authorized Official - Last Name:NAROLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-432-7233
Mailing Address - Street 1:PO BOX 2470
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2470
Mailing Address - Country:US
Mailing Address - Phone:606-432-7233
Mailing Address - Fax:606-432-7255
Practice Address - Street 1:1330 S MAYO TRL
Practice Address - Street 2:NOVA COMPLEX SUITE 301
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2321
Practice Address - Country:US
Practice Address - Phone:606-432-7233
Practice Address - Fax:606-432-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP0016X
KY3002856364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007113722OtherMEDICAID
KY65931784Medicaid
WV0204477000Medicaid
VA007113722OtherMEDICAID