Provider Demographics
NPI:1891328167
Name:PSYCHOLOGY AND PAWS LLC
Entity Type:Organization
Organization Name:PSYCHOLOGY AND PAWS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-703-0045
Mailing Address - Street 1:2601 N BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9433
Mailing Address - Country:US
Mailing Address - Phone:863-703-0045
Mailing Address - Fax:
Practice Address - Street 1:102 S RIDGEWOOD DR STE 1
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-3300
Practice Address - Country:US
Practice Address - Phone:863-703-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty