Provider Demographics
NPI:1215001615
Name:PSYCHOLOGICAL SERVICES & CONSULTING, INC.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES & CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEYSHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MENENDEZ-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:786-391-1383
Mailing Address - Street 1:9570 SW 107TH AVE
Mailing Address - Street 2:SUITE 202C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2788
Mailing Address - Country:US
Mailing Address - Phone:786-391-1383
Mailing Address - Fax:786-391-1384
Practice Address - Street 1:9570 SW 107TH AVE
Practice Address - Street 2:SUITE 202C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:786-391-1383
Practice Address - Fax:786-391-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7278101YM0800X
FLMH3237101YM0800X
FLMH8155101YM0800X
FLPY6744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL769070300Medicaid