Provider Demographics
NPI:1942519020
Name:DISCOVER YOURSELF INCORPORATED
Entity Type:Organization
Organization Name:DISCOVER YOURSELF INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:LYNGVED
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-683-4331
Mailing Address - Street 1:511 SE 5TH AVE
Mailing Address - Street 2:APT. 1812
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2984
Mailing Address - Country:US
Mailing Address - Phone:786-683-4331
Mailing Address - Fax:
Practice Address - Street 1:511 SE 5TH AVE
Practice Address - Street 2:APT. 1812
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2984
Practice Address - Country:US
Practice Address - Phone:786-683-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 10044251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health