Collaborative Psych & Med
in Lakeland, FL. Organization (NPI-2).
NPI number1972088912
StatusActive
Last updated in NPPESSep 26, 2018
Details
- NPI
- 1972088912
- Entity type
- Organization (NPI-2)
- Legal business name
- Collaborative Psych & Med
- Organization subpart
- No
- Enumeration date
- Sep 26, 2018
- Last updated
- Sep 26, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0805X | – | – | Yes | |
| 103TA0700X | Psychologist, Adult Development & Aging | – | – | |
| 171M00000X | Case Manager/Care Coordinator | – | – |
Practice location
4406 S Florida Ave Ste 31Lakeland, FL 33813-2176
Phone 855-732-5292 · Fax 863-583-9926
Mailing address
4406 S Florida Ave Ste 31Lakeland, FL 33813-2176
Phone 855-732-5292 · Fax 863-583-9926
Authorized official
Kelly Wood
Administrator
8557325292
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