Provider Demographics
NPI:1598832206
Name:CENTER FOR PSYCHIATRY
Entity Type:Organization
Organization Name:CENTER FOR PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-582-8833
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-0959
Mailing Address - Country:US
Mailing Address - Phone:256-582-8833
Mailing Address - Fax:256-582-8335
Practice Address - Street 1:1510 GUNTER AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1848
Practice Address - Country:US
Practice Address - Phone:256-582-8833
Practice Address - Fax:256-582-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1457C1041C0700X
AL40192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529801490Medicaid
ALL191Medicare PIN
ALC75919Medicare UPIN