Provider Demographics
| NPI: | 1396705349 |
|---|---|
| Name: | PSY-CARE INC |
| Entity type: | Organization |
| Organization Name: | PSY-CARE INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | LORRAINE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | KELLY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MS, LPCC-S |
| Authorized Official - Phone: | 330-759-2310 |
| Mailing Address - Street 1: | 2980 BELMONT AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | YOUNGSTOWN |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 44505-1834 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 330-759-2310 |
| Mailing Address - Fax: | 330-759-0018 |
| Practice Address - Street 1: | 2980 BELMONT AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | YOUNGSTOWN |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 44505-1834 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 330-759-2310 |
| Practice Address - Fax: | 330-759-0018 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-03-24 |
| Last Update Date: | 2022-01-27 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 2084P0005X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurodevelopmental Disabilities | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OH | 2460313 | Medicaid | |
| OH | 2460313 | Medicaid |
