Provider Demographics
NPI:1881842102
Name:PSY-MED, INC.
Entity Type:Organization
Organization Name:PSY-MED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GUCCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-348-5557
Mailing Address - Street 1:8140 WALNUT HILL LANE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4396
Mailing Address - Country:US
Mailing Address - Phone:214-348-5557
Mailing Address - Fax:214-348-5898
Practice Address - Street 1:8140 WALNUT HILL LANE
Practice Address - Street 2:SUITE 308
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4396
Practice Address - Country:US
Practice Address - Phone:214-348-5557
Practice Address - Fax:214-348-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty