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General NPI Number Information
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NPI Number | 1639296833
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Entity Type | Organization
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Legal Business Name | CUSTODY EVALUATION SERVICES, INC.
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 736 HOLLYWOOD BLVD
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City | HOLLYWOOD
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State | FL
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Zip | 33019-1602
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Country | US
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Telephone | 954-608-7716
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 222025
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City | HOLLYWOOD
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State | FL
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Zip | 33022-2025
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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 | YVETTE TUCHOLSKI-DEKELES
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Credential |
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Telephone | 954-608-7716
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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 | MH5274
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License Number State | FL
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