Provider Demographics
NPI:1417242371
Name:BURCH PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:BURCH PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-419-9070
Mailing Address - Street 1:219 AIKEN HUNT CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8408
Mailing Address - Country:US
Mailing Address - Phone:803-419-9070
Mailing Address - Fax:803-779-3548
Practice Address - Street 1:125 ALPINE CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6385
Practice Address - Country:US
Practice Address - Phone:803-779-3548
Practice Address - Fax:803-779-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8023261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health