Provider Demographics
NPI:1164953972
Name:PSYCH TEST PLLC
Entity Type:Organization
Organization Name:PSYCH TEST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-408-0016
Mailing Address - Street 1:204 FERNHAM PL
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9516
Mailing Address - Country:US
Mailing Address - Phone:336-945-4721
Mailing Address - Fax:
Practice Address - Street 1:5170 NC HIGHWAY 105 S STE 1
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-8734
Practice Address - Country:US
Practice Address - Phone:336-408-0016
Practice Address - Fax:828-898-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001281Medicaid