Provider Demographics
NPI:1760893630
Name:PSYCHOTHERAPY SERVICES
Entity Type:Organization
Organization Name:PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-399-2093
Mailing Address - Street 1:398 CAMINO GARDENS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5827
Mailing Address - Country:US
Mailing Address - Phone:954-399-2093
Mailing Address - Fax:954-463-4609
Practice Address - Street 1:398 CAMINO GARDENS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5827
Practice Address - Country:US
Practice Address - Phone:954-399-2093
Practice Address - Fax:954-463-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11958144OtherCAQH NUMBER