Provider Demographics
NPI:1467800300
Name:PSYMED HEALTH
Entity Type:Organization
Organization Name:PSYMED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUCCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-536-1049
Mailing Address - Street 1:5701 THAMES CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5032
Mailing Address - Country:US
Mailing Address - Phone:214-536-1049
Mailing Address - Fax:469-914-5363
Practice Address - Street 1:2014 BEN MERRITT DR
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3850
Practice Address - Country:US
Practice Address - Phone:214-536-1049
Practice Address - Fax:469-914-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty