Provider Demographics
NPI:1457053449
Name:YOUR PIC LLC
Entity type:Organization
Organization Name:YOUR PIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TALY
Authorized Official - Middle Name:
Authorized Official - Last Name:KADOCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-701-2147
Mailing Address - Street 1:5555 HOLLYWOOD BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6469
Mailing Address - Country:US
Mailing Address - Phone:954-701-2147
Mailing Address - Fax:
Practice Address - Street 1:5555 HOLLYWOOD BLVD STE 302
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6469
Practice Address - Country:US
Practice Address - Phone:954-701-2147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty