Healthcare Provider Details

I. General information

NPI: 1124050240
Provider Name (Legal Business Name): PSYCHIATRIC & PSYCHOLOGICAL SVCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 ALICIA RD
LAKELAND FL
33801-2104
US

IV. Provider business mailing address

930 ALICIA RD
LAKELAND FL
33801-2104
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-1950
  • Fax: 863-683-4654
Mailing address:
  • Phone: 863-680-1950
  • Fax: 863-683-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. KATE COHEN-POSEY
Title or Position: DIRECTOR PSYCHIATRIC & PSYCHOLOGICA
Credential: MS LICENSED MENTAL H
Phone: 863-680-1950