Provider Demographics
NPI:1891373601
Name:PSYCHIATRIC SERVICES OF DAYTONA, PLCC
Entity type:Organization
Organization Name:PSYCHIATRIC SERVICES OF DAYTONA, PLCC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:386-265-5512
Mailing Address - Street 1:600 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2322
Mailing Address - Country:US
Mailing Address - Phone:386-265-5512
Mailing Address - Fax:386-265-5543
Practice Address - Street 1:600 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2322
Practice Address - Country:US
Practice Address - Phone:386-265-5512
Practice Address - Fax:386-265-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty