Provider Demographics
NPI: | 1376011577 |
---|---|
Name: | ARCHES PSYCHIATRIC SERVICES, PLLC |
Entity Type: | Organization |
Organization Name: | ARCHES PSYCHIATRIC SERVICES, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PROVIDER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHIRLEY |
Authorized Official - Middle Name: | KELLY |
Authorized Official - Last Name: | LABRECQUE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 978-792-2211 |
Mailing Address - Street 1: | 1794 BRIDGE ST STE 18B |
Mailing Address - Street 2: | |
Mailing Address - City: | DRACUT |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01826-2664 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 978-219-6710 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1794 BRIDGE ST STE 18B |
Practice Address - Street 2: | |
Practice Address - City: | DRACUT |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01826-2664 |
Practice Address - Country: | US |
Practice Address - Phone: | 978-219-6710 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-11-06 |
Last Update Date: | 2020-02-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |