1497789424 NPI number — PSYCH 2 U PLLC

Table of content: (NPI 1497789424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497789424 NPI number — PSYCH 2 U PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCH 2 U PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497789424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7945 1ST AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33707-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-214-7079
Provider Business Mailing Address Fax Number:
954-245-3143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7945 1ST AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33707-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-214-7079
Provider Business Practice Location Address Fax Number:
954-245-3143
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHOENFELT
Authorized Official First Name:
REBA
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
MEMBER MANAGER
Authorized Official Telephone Number:
727-214-7079

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  3027792 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: L06000021570 . This is a "ASSIGNED DOCUMENT NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".