Provider Demographics
NPI:1851611040
Name:PSYCHIATRIC SERVICES, L.L.C.
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:AMNON
Authorized Official - Middle Name:ISRAEL
Authorized Official - Last Name:KAHANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:6024-344-4541
Mailing Address - Street 1:2525 W BERYL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-1606
Mailing Address - Country:US
Mailing Address - Phone:602-434-4541
Mailing Address - Fax:
Practice Address - Street 1:4146 N 12TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4932
Practice Address - Country:US
Practice Address - Phone:602-434-4541
Practice Address - Fax:602-282-3894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23948103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ451485Medicaid