Healthcare Provider Details

I. General information

NPI: 1275771941
Provider Name (Legal Business Name): THE PSYCH TEAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 STIRLING ROAD SUITE 6
COOPER CITY FL
33024
US

IV. Provider business mailing address

10400 GRIFFIN ROAD, SUITE 101 SUITE 101
COOPER CITY FL
33328
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-8326
  • Fax: 954-433-0603
Mailing address:
  • Phone: 954-436-8326
  • Fax: 954-433-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 0954
License Number StateFL

VIII. Authorized Official

Name: MR. JAY SAMUEL WOOLFSTEAD
Title or Position: PRESIDENT
Credential: M.S.
Phone: 954-436-8326