MEDICARE: TYKES & TEENS, INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	15-43-AD-0899-00	FL
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker
4	251B00000X	Case Management Agency
5	363LP0200X	Pediatric Nurse Practitioner
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9469081	FL
7	251S00000X	Community/Behavioral Health Agency

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

NPI Number	:	1093710303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYKES & TEENS, INC.

Provider Business Mailing Address
First Line	:	900 SE OCEAN BLVD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2471
Country	:	US
Telephone Number	:	772-220-3439
Fax Number	:	772-220-3484

Provider Business Practice Location Address
First Line	:	900 SE OCEAN BLVD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-3502
Country	:	US
Telephone Number	:	772-220-3439
Fax Number	:	772-220-3484

Authorized Official
Title or Position	:	BILLING & CREDENTIALING SPECIALIST
Name	:	RACHEL SWEIKERT
Credential	:
Telephone Number	:	772-220-3439

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/16/2025

900 SE OCEAN BLVD STE 340E
STUART, FL
34994-3502

Practice Phone: 772-220-3439
Practice Fax: 772-220-3484