Provider Demographics
NPI:1336448539
Name:DRISKELL, JUDITH (PSYS)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:DRISKELL
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 JAMES MELVIN DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-5300
Mailing Address - Country:US
Mailing Address - Phone:813-892-7278
Mailing Address - Fax:813-441-4460
Practice Address - Street 1:2902 JAMES MELVIN DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33565-5300
Practice Address - Country:US
Practice Address - Phone:813-892-7278
Practice Address - Fax:813-441-4460
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1050103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool