Provider Demographics
NPI:1356526396
Name:DR BRENT MRUZ PSYD PA
Entity type:Organization
Organization Name:DR BRENT MRUZ PSYD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:352-351-4940
Mailing Address - Street 1:1701 NE 42ND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-8022
Mailing Address - Country:US
Mailing Address - Phone:352-351-4940
Mailing Address - Fax:352-351-8902
Practice Address - Street 1:1701 NE 42ND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8022
Practice Address - Country:US
Practice Address - Phone:352-351-4940
Practice Address - Fax:352-351-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7508251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health