Provider Demographics
NPI:1992388805
Name:PSYCH 4 U LLC
Entity Type:Organization
Organization Name:PSYCH 4 U LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND COMPLIANCE OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-431-9838
Mailing Address - Street 1:2010 NW 150TH AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2888
Mailing Address - Country:US
Mailing Address - Phone:954-431-9838
Mailing Address - Fax:954-241-6726
Practice Address - Street 1:2010 NW 150TH AVE
Practice Address - Street 2:STE 120
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2888
Practice Address - Country:US
Practice Address - Phone:954-431-9838
Practice Address - Fax:954-241-6726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty