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General NPI Number Information
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NPI Number | 1740620525
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Entity Type | Organization
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Legal Business Name | FOUR SEASONS PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 777 37TH ST SUITE B107
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City | VERO BEACH
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State | FL
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Zip | 32960-4873
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Country | US
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Telephone | 772-538-1038
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Fax |
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Provider Business Mailing Address
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Address Line | 3625 EAGLE DR
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City | VERO BEACH
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State | FL
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Zip | 32963-1650
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Country | US
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Telephone | 772-538-1038
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SOREN JAMES BARRETT
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Credential | PH.D.
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Telephone | 772-538-4656
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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 | PY4688
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License Number State | FL
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