Provider Demographics
NPI:1144396011
Name:PSYCH SERVICES INC
Entity Type:Organization
Organization Name:PSYCH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUFF-BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-777-9200
Mailing Address - Street 1:26777 LORAIN RD
Mailing Address - Street 2:SUITE 716
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3200
Mailing Address - Country:US
Mailing Address - Phone:440-777-9200
Mailing Address - Fax:440-777-9288
Practice Address - Street 1:26777 LORAIN RD
Practice Address - Street 2:SUITE 716
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3200
Practice Address - Country:US
Practice Address - Phone:440-777-9200
Practice Address - Fax:440-777-9288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3637103TA0700X, 103TC0700X, 103TC2200X
OH172641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0278684Medicaid
OH0278684Medicaid
CP14118Medicare PIN