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General NPI Number Information
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NPI Number | 1104190180
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Entity Type | Organization
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Legal Business Name | LIFE SOLUTIONS PSYCHOLOGICAL SERVICES, P.A.
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 4121 NW 5TH ST SUITE 207
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City | PLANTATION
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State | FL
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Zip | 33317-2120
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Country | US
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Telephone | 954-583-4568
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 NW 5TH ST SUITE 207
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City | PLANTATION
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State | FL
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Zip | 33317-2120
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Country | US
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Telephone | 954-583-4568
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LATOYA E SHAKES MALONE
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Credential | PH.D.
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Telephone | 954-583-4568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | PY7376
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY7376
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License Number State | FL
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