Healthcare Provider Details

I. General information

NPI: 1639920325
Provider Name (Legal Business Name): JT VIRTUAL PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WOLCOTT LN
OLD LYME CT
06371-1147
US

IV. Provider business mailing address

7 WOLCOTT LN
OLD LYME CT
06371-1147
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-8313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOYCE TINSLEY
Title or Position: CEO
Credential: MD
Phone: 813-397-8313