Provider Demographics
NPI:1114915840
Name:PSYCHIATRIC SERVICES, INC
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:STREETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-614-7712
Mailing Address - Street 1:5208 KAVANAUGH BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-4609
Mailing Address - Country:US
Mailing Address - Phone:501-614-7712
Mailing Address - Fax:501-614-7708
Practice Address - Street 1:5208 KAVANAUGH BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-4609
Practice Address - Country:US
Practice Address - Phone:501-614-7712
Practice Address - Fax:501-614-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE 1489323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility