| Organization Name: | PSYCHED GROUP, LLC |
| NPI Number: | 1386039105 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH N BEAUPRE (PRACTICE MANAGER) |
| Mailing Address: | 205 W Grove St Ste B2 Middleboro |
| State: | MA US |
| Postal Code: | 023461462 |
| Phone Number: | 6176579838 |
| Fax Number: | 8889784883 |
| NPI Enumeration Date: | 03/30/2015 |
| NPI Last Update Date: | 10/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MHC00668 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |