MEDICARE: TOTAL PERSON PSYCHOLOGICAL ASSOCIATES PA

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	103T00000X	Psychologist	PY7984	FL

General Provider Information

NPI Number	:	1487989034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL PERSON PSYCHOLOGICAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	9309 BLIND PASS ROAD
Second Line	:
City	:	ST PETE BEACH
State	:	FL
Zip	:	33706
Country	:	US
Telephone Number	:	727-412-8003
Fax Number	:	866-469-3880

Provider Business Practice Location Address
First Line	:	6739 1ST AVENUE SOUTH
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-0000
Country	:	US
Telephone Number	:	727-412-8003
Fax Number	:	866-469-3880

Authorized Official
Title or Position	:	OWNER/AUTHORIZED OFFICIAL
Name	:	LYNNETTE D MACKENZIE
Credential	:	PSYD
Telephone Number	:	727-412-8003

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	12/03/2010

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