Provider Demographics
NPI: | 1821438409 |
---|---|
Name: | PSYCARE, INC. |
Entity Type: | Organization |
Organization Name: | PSYCARE, INC. |
Other - Org Name: | JBOGNIARD COUNSELING ASSOCIATES LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CLINICAL DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JEFFREY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BOGNIARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MED, LPCCS |
Authorized Official - Phone: | 330-318-3078 |
Mailing Address - Street 1: | 520 YOUNGSTOWN POLAND RD |
Mailing Address - Street 2: | |
Mailing Address - City: | STRUTHERS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44471-1103 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 330-318-3078 |
Mailing Address - Fax: | 234-855-1072 |
Practice Address - Street 1: | 520 YOUNGSTOWN POLAND RD. |
Practice Address - Street 2: | |
Practice Address - City: | STRUTHERS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44471 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-318-3078 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-06-27 |
Last Update Date: | 2013-09-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 0002308 | 101Y00000X, 101YA0400X, 101YS0200X, 102L00000X, 103TA0700X, 103TC1900X, 103TP2701X |
0002308 | 101YM0800X, 101YP2500X, 103TB0200X, 103TC0700X, 104100000X, 106H00000X | |
0 | 103T00000X | |
OH | 0 | 103TA0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 101YS0200X | Behavioral Health & Social Service Providers | Counselor | School | Group - Multi-Specialty |
No | 102L00000X | Behavioral Health & Social Service Providers | Psychoanalyst | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty |