Healthcare Provider Details

I. General information

NPI: 1578692687
Provider Name (Legal Business Name): REGIONAL PSYCHOTHERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 23RD ST
ASHLAND KY
41101-7812
US

IV. Provider business mailing address

332 23RD ST
ASHLAND KY
41101-7812
US

V. Phone/Fax

Practice location:
  • Phone: 606-326-0322
  • Fax: 606-326-9809
Mailing address:
  • Phone: 606-326-0322
  • Fax: 606-326-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4236P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT J. LANCE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 606-326-0322