Provider Demographics
NPI:1891373601
Name:PSYCHIATRIC SERVICES OF DAYTONA, PLCC
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES OF DAYTONA, PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:386-265-5512
Mailing Address - Street 1:1651 N CLYDE MORRIS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5500
Mailing Address - Country:US
Mailing Address - Phone:386-265-5512
Mailing Address - Fax:
Practice Address - Street 1:1651 N CLYDE MORRIS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5500
Practice Address - Country:US
Practice Address - Phone:386-265-5512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty