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General NPI Number Information
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NPI Number | 1528252137
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPEUTIC SERVICES OF FLORIDA
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 323 SGT JOE JONES RD
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City | IMMOKALEE
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State | FL
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Zip | 34142-4364
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Country | US
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Telephone | 239-657-2130
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Fax | 239-657-2930
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Provider Business Mailing Address
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Address Line | 870 HIGH ST SUITE 2
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City | CHESTERTOWN
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State | MD
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Zip | 21620-3909
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Country | US
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Telephone | 410-778-9114
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Fax |
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Authorized Official
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Title or Position | CPA
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Name | RANDALL COOPER
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Credential | CFO
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Telephone | 410-778-9114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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