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General NPI Number Information
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NPI Number | 1942952312
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Entity Type | Organization
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Legal Business Name | DR PSYCHOLOGIST LLC
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 26829 TANIC DR STE 101
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-4612
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Country | US
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Telephone | 813-219-0152
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Fax |
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Provider Business Mailing Address
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Address Line | 2870 SATILLA LOOP
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City | ODESSA
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State | FL
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Zip | 33556-2736
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Country | US
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Telephone | 813-219-0152
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA PENA MORALES
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Credential |
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Telephone | 813-219-0152
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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 |
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License Number State |
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