Provider Demographics
NPI:1023862711
Name:FIRST CHOICE PSYCHIATRY LLC
Entity type:Organization
Organization Name:FIRST CHOICE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MCCULLY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:541-419-4054
Mailing Address - Street 1:61822 TEN BARR RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9314
Mailing Address - Country:US
Mailing Address - Phone:541-419-4054
Mailing Address - Fax:
Practice Address - Street 1:61822 TEN BARR RANCH RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9314
Practice Address - Country:US
Practice Address - Phone:541-419-4054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & FamilyGroup - Single Specialty