Provider Demographics
NPI:1073659603
Name:PSYCARE, INC.
Entity Type:Organization
Organization Name:PSYCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HELTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-856-6663
Mailing Address - Street 1:997 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4223
Mailing Address - Country:US
Mailing Address - Phone:330-758-0101
Mailing Address - Fax:330-758-0128
Practice Address - Street 1:997 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4223
Practice Address - Country:US
Practice Address - Phone:330-758-0101
Practice Address - Fax:330-758-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YP2500X, 103T00000X, 103TC0700X, 103TC1900X, 104100000X, 1041C0700X, 2084P0800X, 2084P0804X
OH0004100101YP2500X
OHE4004101YP2500X
OHE 500055101YP2500X
OH202103TC0700X
OHE 2309103TC1900X
OHI. 00057701041C0700X
OHI 00057701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9219952Medicare PIN