Provider Demographics
NPI:1104445394
Name:UNIVERSAL PSYCHIATRY LLC
Entity type:Organization
Organization Name:UNIVERSAL PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:919-257-0067
Mailing Address - Street 1:18 HOLSTON HILLS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6642
Mailing Address - Country:US
Mailing Address - Phone:034-760-4416
Mailing Address - Fax:
Practice Address - Street 1:18 HOLSTON HILLS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-6642
Practice Address - Country:US
Practice Address - Phone:034-760-4416
Practice Address - Fax:702-852-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty