Provider Demographics
NPI:1093171787
Name:PSYCH-ED SERVICES INC.
Entity Type:Organization
Organization Name:PSYCH-ED SERVICES INC.
Other - Org Name:PSYCH-ED COUNSELING SERVICES FOR CHILDREN AND FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MCDONALD
Authorized Official - Last Name:KENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LMHC, NBCC,
Authorized Official - Phone:941-916-5291
Mailing Address - Street 1:PO BOX 7020
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34290-0020
Mailing Address - Country:US
Mailing Address - Phone:941-916-5291
Mailing Address - Fax:
Practice Address - Street 1:207 CROSS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4432
Practice Address - Country:US
Practice Address - Phone:941-916-5291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003976200Medicaid