Provider Demographics
NPI:1760718910
Name:ULTIMATE THINKING PSYCHOLOGICAL CONSULTANTS, PA
Entity Type:Organization
Organization Name:ULTIMATE THINKING PSYCHOLOGICAL CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:XUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:386-243-5228
Mailing Address - Street 1:PO BOX 291725
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-1725
Mailing Address - Country:US
Mailing Address - Phone:386-243-5228
Mailing Address - Fax:877-601-7246
Practice Address - Street 1:100 E GRANADA BLVD STE 219D
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6660
Practice Address - Country:US
Practice Address - Phone:386-243-5228
Practice Address - Fax:877-601-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7888103TC1900X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty