Provider Demographics
NPI:1295916443
Name:INDEPENDENT PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:INDEPENDENT PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:INYANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-856-8516
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-0190
Mailing Address - Country:US
Mailing Address - Phone:301-856-8516
Mailing Address - Fax:301-856-8515
Practice Address - Street 1:7905 MALCOLM RD STE 103A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1734
Practice Address - Country:US
Practice Address - Phone:301-856-8516
Practice Address - Fax:301-856-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251S00000X
MDD00613081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty