Provider Demographics
NPI:1194130435
Name:MY PSY LLC
Entity type:Organization
Organization Name:MY PSY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:FLEITAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-297-4418
Mailing Address - Street 1:1200 14TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-4907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 14TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-4907
Practice Address - Country:US
Practice Address - Phone:334-297-4418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty