Provider Demographics
NPI:1326455783
Name:NOVUSVITA
Entity Type:Organization
Organization Name:NOVUSVITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:H
Authorized Official - Last Name:KUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-872-8627
Mailing Address - Street 1:612 E COLONIAL DR
Mailing Address - Street 2:SUITE 390
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4650
Mailing Address - Country:US
Mailing Address - Phone:321-872-8627
Mailing Address - Fax:
Practice Address - Street 1:612 E COLONIAL DR
Practice Address - Street 2:SUITE 390
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4650
Practice Address - Country:US
Practice Address - Phone:321-872-8627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH6666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty