Provider Demographics
NPI:1053793059
Name:ADVANCED PSYCHOTHERAPEUTICS
Entity type:Organization
Organization Name:ADVANCED PSYCHOTHERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BARCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-616-2388
Mailing Address - Street 1:1047 VISTA PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4362
Mailing Address - Country:US
Mailing Address - Phone:434-616-2388
Mailing Address - Fax:
Practice Address - Street 1:1047 VISTA PARK DR STE A
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4362
Practice Address - Country:US
Practice Address - Phone:434-616-2388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TA0400X, 103TB0200X, 103TP2701X
VA0810004569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972591071OtherINDIVIDUAL