Healthcare Provider Details

I. General information

NPI: 1992127435
Provider Name (Legal Business Name): OPTIMUM PSYCHOLOGY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 PINES BLVD SUITE 325
PEMBROKE PINES FL
33027-1212
US

IV. Provider business mailing address

15800 PINES BLVD SUITE 325
PEMBROKE PINES FL
33027-1212
US

V. Phone/Fax

Practice location:
  • Phone: 954-362-5395
  • Fax:
Mailing address:
  • Phone: 954-362-5395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MIGUEL A PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 954-362-5395