Provider Demographics
NPI:1124556840
Name:GET PSYCHED BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:GET PSYCHED BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GIBB
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:813-360-3569
Mailing Address - Street 1:15210 AMBERLY DRIVE
Mailing Address - Street 2:#625
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:813-360-3569
Mailing Address - Fax:
Practice Address - Street 1:4929 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4813
Practice Address - Country:US
Practice Address - Phone:813-360-3569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12739OtherREGISTERED MENTAL HEALTH INTERN