Basic Information
| Provider Information | |||||||||
| NPI: | 1992388805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCH 4 U LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 NW 150TH AVE | ||||||||
| Address2: | STE 120 | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330282888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544319838 | ||||||||
| FaxNumber: | 9542416726 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 NW 150TH AVE | ||||||||
| Address2: | STE 120 | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330282888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544319838 | ||||||||
| FaxNumber: | 9542416726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2021 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEYVA | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING AND COMPLIANCE OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 9544319838 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 363L00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 101YM0800X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.