Basic Information
| Provider Information | |||||||||
| NPI: | 1194239202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TELE-PSYCHIATRY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3475 BELLE CHASE WAY | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48911 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 824 HIDEAWAY CIR. E. UNIT 312 | ||||||||
| Address2: | |||||||||
| City: | MARCO ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178823732 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2017 | ||||||||
| LastUpdateDate: | 11/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | PICONE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5778823732 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.