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General NPI Number Information
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NPI Number | 1326455783
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Entity Type | Organization
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Legal Business Name | NOVUSVITA
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 612 E COLONIAL DR SUITE 390
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City | ORLANDO
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State | FL
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Zip | 32803-4650
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Country | US
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Telephone | 321-872-8627
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Fax |
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Provider Business Mailing Address
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Address Line | 612 E COLONIAL DR SUITE 390
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City | ORLANDO
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State | FL
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Zip | 32803-4650
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Country | US
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Telephone | 321-872-8627
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | DR. TYSON H KUCH
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Credential | PHD
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Telephone | 321-872-8627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH6666
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License Number State | FL
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