Provider Demographics
NPI:1578692687
Name:REGIONAL PSYCHOTHERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:REGIONAL PSYCHOTHERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-326-0322
Mailing Address - Street 1:332 23RD ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7812
Mailing Address - Country:US
Mailing Address - Phone:606-326-0322
Mailing Address - Fax:606-326-9809
Practice Address - Street 1:332 23RD ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7812
Practice Address - Country:US
Practice Address - Phone:606-326-0322
Practice Address - Fax:606-326-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 104100000X, 2084P0800X
KY4236P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0163120Medicaid
KY65923393Medicaid
OH0163120Medicaid