Provider Demographics
NPI:1689454613
Name:TREASURE COAST NEUROPSYCHOLOGY PA
Entity Type:Organization
Organization Name:TREASURE COAST NEUROPSYCHOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TANTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:772-278-5508
Mailing Address - Street 1:10570 S US HIGHWAY 1 STE 300
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5606
Mailing Address - Country:US
Mailing Address - Phone:772-278-5508
Mailing Address - Fax:772-673-6225
Practice Address - Street 1:10570 S US HIGHWAY 1 STE 300
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5606
Practice Address - Country:US
Practice Address - Phone:772-278-5508
Practice Address - Fax:772-673-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health