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General NPI Number Information
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NPI Number | 1881947406
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 3740 20TH ST SUITE B
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City | VERO BEACH
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State | FL
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Zip | 32960-2418
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Country | US
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Telephone | 772-567-9955
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Fax | 772-257-6970
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Provider Business Mailing Address
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Address Line | 3740 20TH ST SUITE B
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City | VERO BEACH
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State | FL
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Zip | 32960-2418
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Country | US
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Telephone | 772-567-9955
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Fax | 772-257-6970
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Authorized Official
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Title or Position | OWNER
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Name | MS. JULIE BARKER TINSLEY
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Credential | LCSW
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Telephone | 772-567-9955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | SW5919
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License Number State | FL
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