| Psychotherapy And Consultation | |
|
504 Parkview Dr Spartanburg SC 29302-4019 | |
| (864) 504-0708 | |
| Not Available |
| Full Name | Psychotherapy And Consultation |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 504 Parkview Dr, Spartanburg, South Carolina |
| Authorized Official Name and Position | Lisa L Judd (SOLE PROPRIETOR) |
| Authorized Official Contact | 8645040708 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychotherapy And Consultation 504 Parkview Dr Spartanburg SC 29302-4019 Ph: (864) 504-0708 | Psychotherapy And Consultation 504 Parkview Dr Spartanburg SC 29302-4019 Ph: (864) 504-0708 |
| NPI Number | 1740630045 |
|---|---|
| Provider Enumeration Date | 06/16/2016 |
| Last Update Date | 08/10/2016 |
| Medicare PECOS PAC ID | 6204120801 |
|---|---|
| Medicare Enrollment ID | O20160804001069 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740630045 | NPI | - | NPPES |
| SW1292-1417958448 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 0069 (South Carolina) | Primary |
| Provider Name | Lisa L Judd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417958448 PECOS PAC ID: 7517955180 Enrollment ID: I20040503001256 |
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