Provider Demographics
NPI:1093709461
Name:ADVANCED PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED PSYCHIATRIC SERVICES, LLC
Other - Org Name:TALK IT OUT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:337-310-0153
Mailing Address - Street 1:840 W BAYOU PINES DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7077
Mailing Address - Country:US
Mailing Address - Phone:337-310-0153
Mailing Address - Fax:337-310-0202
Practice Address - Street 1:840 W BAYOU PINES DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7077
Practice Address - Country:US
Practice Address - Phone:337-310-0153
Practice Address - Fax:337-310-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5CJ08Medicare ID - Type Unspecified