Organization
PSYCHIATRIC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA L JOHNSON MS-CNP (OWNER)
(605) 529-5240
Entity
Organization
Contact information
Practice address
506 LOVELY AVE, BALTIC, SD 57003-0328
(605) 529-5240
(605) 610-1561
Mailing address
506 LOVELY AVE, P.O. BOX 328, BALTIC, SD 57003-0328
(605) 529-5240
(605) 610-1561
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
CP000650
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20110813516668
—
SD
Enumeration date
11/19/2011
Last updated
05/30/2012
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