Provider Demographics
NPI:1942614854
Name:YOUTH PSYCHOLOGICAL ASSESSMENT & THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:YOUTH PSYCHOLOGICAL ASSESSMENT & THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-689-2525
Mailing Address - Street 1:1452 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4853
Mailing Address - Country:US
Mailing Address - Phone:813-689-2525
Mailing Address - Fax:813-689-4433
Practice Address - Street 1:1452 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4853
Practice Address - Country:US
Practice Address - Phone:813-689-2525
Practice Address - Fax:813-689-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty