Healthcare Provider Details

I. General information

NPI: 1740145333
Provider Name (Legal Business Name): INNOVED PSYCH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 SE 47TH ST
CAPE CORAL FL
33904-9661
US

IV. Provider business mailing address

1428 SE 31ST ST
CAPE CORAL FL
33904-3983
US

V. Phone/Fax

Practice location:
  • Phone: 239-788-6810
  • Fax:
Mailing address:
  • Phone: 208-755-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: AMY CLARK
Title or Position: MBR/OWNER
Credential: MS, EDS, LSP
Phone: 208-755-4993