Provider Demographics
NPI:1356795629
Name:FLORIDA PSYCH SERVICES INC.
Entity type:Organization
Organization Name:FLORIDA PSYCH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCUDDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-478-7984
Mailing Address - Street 1:13436 SW PEMBROKE CIR N
Mailing Address - Street 2:
Mailing Address - City:LAKE SUZY
Mailing Address - State:FL
Mailing Address - Zip Code:34269-6909
Mailing Address - Country:US
Mailing Address - Phone:239-478-7984
Mailing Address - Fax:
Practice Address - Street 1:13436 SW PEMBROKE CIR N
Practice Address - Street 2:
Practice Address - City:LAKE SUZY
Practice Address - State:FL
Practice Address - Zip Code:34269-6909
Practice Address - Country:US
Practice Address - Phone:239-478-7984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty