Healthcare Provider Details

I. General information

NPI: 1306229612
Provider Name (Legal Business Name): LETTVIN PSYCHIATRIC AND CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 E. SECOND STREET
CHILLICOTHEE OH
45601
US

IV. Provider business mailing address

76 E. SECOND STREET P.O. BOX 507
CHILLICOTHEE OH
45601
US

V. Phone/Fax

Practice location:
  • Phone: 740-772-2902
  • Fax: 740-772-2906
Mailing address:
  • Phone: 740-772-2902
  • Fax: 740-772-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBYN ME LETTVIN
Title or Position: GENERAL PARTNER
Credential: LISW-S
Phone: 740-772-2902