Provider Demographics
NPI:1497789424
Name:PSYCH 2 U PLLC
Entity Type:Organization
Organization Name:PSYCH 2 U PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SHOENFELT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:727-214-7079
Mailing Address - Street 1:7945 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1019
Mailing Address - Country:US
Mailing Address - Phone:727-214-7079
Mailing Address - Fax:954-245-3143
Practice Address - Street 1:7945 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1019
Practice Address - Country:US
Practice Address - Phone:727-214-7079
Practice Address - Fax:954-245-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3027792363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL06000021570OtherASSIGNED DOCUMENT NUMBER