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General NPI Number Information
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NPI Number | 1659658698
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Entity Type | Organization
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Legal Business Name | THERAPY CENTER OF BREVARD, LLC
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 380 NEWPORT DR
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City | INDIALANTIC
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State | FL
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Zip | 32903-4021
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Country | US
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Telephone | 321-722-9986
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Fax |
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Provider Business Mailing Address
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Address Line | 870 N MIRAMAR AVE # 345
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City | INDIALANTIC
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State | FL
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Zip | 32903-3054
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Country | US
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Telephone | 321-722-9986
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. HAYA SOYA
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Credential | PSY.D.
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Telephone | 321-328-7692
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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 | PY8406
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License Number State | FL
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