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General NPI Number Information
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NPI Number | 1396479697
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Entity Type | Organization
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Legal Business Name | TOTALLY PSYCHED, LLC
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1223 DANIELS RD
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City | WINTER GARDEN
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State | FL
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Zip | 34787-3835
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Country | US
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Telephone | 689-240-7945
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Fax | 833-973-2664
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Provider Business Mailing Address
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Address Line | 15161 NEWTONIA ST
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5647
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Country | US
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Telephone | 817-689-3369
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KRISTOPHER STEWART OLDHAM
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Credential | PMHNP-BC
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Telephone | 817-689-3369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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