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General NPI Number Information
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NPI Number | 1689002362
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Entity Type | Organization
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Legal Business Name | PSY-CREST PSYCHOLOGICAL ASSOCIATES
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 4213 SUMMIT CREEK BLVD APT 7107
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City | ORLANDO
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State | FL
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Zip | 32837-4503
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Country | US
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Telephone | 850-346-1634
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Fax |
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Provider Business Mailing Address
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Address Line | 4213 SUMMIT CREEK BLVD APT 7107
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City | ORLANDO
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State | FL
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Zip | 32837-4503
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Country | US
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Telephone | 850-346-1634
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Fax |
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Authorized Official
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Title or Position | OPERATIONS OFFICER
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Name | RICHARD SANDERS
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Credential |
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Telephone | 850-346-1634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY8870
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License Number State | FL
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