Healthcare Provider Details

I. General information

NPI: 1962541375
Provider Name (Legal Business Name): SPRINGFIELD PSYCHIATRIC ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3162 EL CAMINO DR
SPRINGFIELD OH
45503-1318
US

IV. Provider business mailing address

3162 EL CAMINO DR
SPRINGFIELD OH
45503-1318
US

V. Phone/Fax

Practice location:
  • Phone: 937-342-9030
  • Fax: 937-342-9039
Mailing address:
  • Phone: 937-342-9030
  • Fax: 937-342-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0002982
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.0002982
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35063060
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35063060
License Number StateOH

VIII. Authorized Official

Name: PRAMILA VELLANKI
Title or Position: OFFICE MANAGER
Credential:
Phone: 937-342-9030