Provider Demographics
NPI:1538472485
Name:PSYCHOLOGICAL FITNESS ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL FITNESS ASSOCIATES, LLC
Other - Org Name:PSYCHFITNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:FREELAND
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-291-1344
Mailing Address - Street 1:21903 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-3219
Mailing Address - Country:US
Mailing Address - Phone:850-588-7089
Mailing Address - Fax:850-250-5759
Practice Address - Street 1:21903 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-3219
Practice Address - Country:US
Practice Address - Phone:850-588-7089
Practice Address - Fax:850-250-5759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty