Provider Demographics
NPI:1013073980
Name:VISTA PSYCHOLOGICAL SERVICES, PA
Entity Type:Organization
Organization Name:VISTA PSYCHOLOGICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:407-657-5800
Mailing Address - Street 1:PO BOX 4728
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32793-4728
Mailing Address - Country:US
Mailing Address - Phone:407-657-5800
Mailing Address - Fax:407-657-4269
Practice Address - Street 1:120 UNIVERSITY PARK DR
Practice Address - Street 2:SUITE 215
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4440
Practice Address - Country:US
Practice Address - Phone:407-657-5800
Practice Address - Fax:407-657-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1561101YM0800X
FLMH3101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty