Healthcare Provider Details

I. General information

NPI: 1922912096
Provider Name (Legal Business Name): PIXEL FUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 BALLISTIC TIP CT
CANTONMENT FL
32533-7346
US

IV. Provider business mailing address

1315 BALLISTIC TIP CT
CANTONMENT FL
32533-7346
US

V. Phone/Fax

Practice location:
  • Phone: 302-618-7675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: YAZEN NICOLE
Title or Position: CEO
Credential:
Phone: 812-561-1223