Healthcare Provider Details

I. General information

NPI: 1891328167
Provider Name (Legal Business Name): PSYCHOLOGY AND PAWS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S RIDGEWOOD DR STE 1
SEBRING FL
33870-3300
US

IV. Provider business mailing address

2601 N BRANDON RD
AVON PARK FL
33825-9433
US

V. Phone/Fax

Practice location:
  • Phone: 863-703-0045
  • Fax:
Mailing address:
  • Phone: 863-703-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. TERESA GONZALEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 863-703-0045