Provider Demographics
NPI:1851010672
Name:PSYCHSIS LTD LIABILITY COMPANY
Entity Type:Organization
Organization Name:PSYCHSIS LTD LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TADONGDOUONNANG
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:559-404-9387
Mailing Address - Street 1:351 WARTHAN ST APT 120
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-2654
Mailing Address - Country:US
Mailing Address - Phone:559-404-9387
Mailing Address - Fax:
Practice Address - Street 1:351 WARTHAN ST APT 120
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-2654
Practice Address - Country:US
Practice Address - Phone:559-404-9387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes167G00000XNursing Service ProvidersLicensed Psychiatric TechnicianGroup - Multi-Specialty