MEDICARE: PSYCHOTHERAPEUTIC TREATMENT SERVICES

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	320800000X	Mental Illness Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013050061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOTHERAPEUTIC TREATMENT SERVICES

Provider Business Mailing Address
First Line	:	870 HIGH ST
Second Line	:	SUITE 2
City	:	CHESTERTOWN
State	:	MD
Zip	:	21620-3914
Country	:	US
Telephone Number	:	410-778-1099
Fax Number	:	410-778-7988

Provider Business Practice Location Address
First Line	:	839 BESTGATE RD
Second Line	:	SUITE 400A
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3472
Country	:	US
Telephone Number	:	410-224-1188
Fax Number	:	410-224-3711

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. RANDALL L COOPER
Credential	:	CPA
Telephone Number	:	410-810-2468

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	02/16/2017

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Directions to “PSYCHOTHERAPEUTIC TREATMENT SERVICES ” Practice Location

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