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General NPI Number Information
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NPI Number | 1326414848
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Entity Type | Organization
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Legal Business Name | SILVER SANDS PSYCHOLOGICAL, INC.
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 48 DICKENS DR
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City | FREEPORT
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State | FL
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Zip | 32439-2297
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Country | US
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Telephone | 850-974-0353
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Fax |
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Provider Business Mailing Address
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Address Line | 48 DICKENS DR
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City | FREEPORT
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State | FL
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Zip | 32439-2297
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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 | RACHELLE HUFSTEDLER
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Credential |
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Telephone | 850-974-0353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY9253
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License Number State | FL
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