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General NPI Number Information
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NPI Number | 1134573512
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Entity Type | Organization
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Legal Business Name | TREASURE COAST PSYCHOLOGY, INC.
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 819 SW FEDERAL HWY STE 200B
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City | STUART
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State | FL
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Zip | 34994-2952
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Country | US
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Telephone | 561-531-8356
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Fax |
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Provider Business Mailing Address
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Address Line | 819 SW FEDERAL HWY STE 200B
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City | STUART
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State | FL
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Zip | 34994-2952
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JIMMY L MIDDLEBROOK
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Credential | PH.D.
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Telephone | 561-531-8356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | PY 9495
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PY 9495
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License Number State | FL
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