MEDICARE: PSYCHIATRIC CARE MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	A85774	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A857740	OTHER	CA	PIN NUMBER

General Provider Information

NPI Number	:	1437175619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHIATRIC CARE MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	3455 WESTRIDGE DR
Second Line	:
City	:	KELSEYVILLE
State	:	CA
Zip	:	95451-8227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 WESTRIDGE DR
Second Line	:
City	:	KELSEYVILLE
State	:	CA
Zip	:	95451-8227
Country	:	US
Telephone Number	:	707-279-2932
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OLGA SEGAL
Credential	:	MD
Telephone Number	:	707-279-2932

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	10/20/2009

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Directions to “PSYCHIATRIC CARE MEDICAL CORPORATION ” Practice Location

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