Provider Demographics
NPI:1194553735
Name:TCC PSYCHOTHERAPY
Entity type:Organization
Organization Name:TCC PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYNASHKEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-527-4796
Mailing Address - Street 1:12348 SW NETTUNO WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-5436
Mailing Address - Country:US
Mailing Address - Phone:601-527-4796
Mailing Address - Fax:
Practice Address - Street 1:12348 SW NETTUNO WAY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-5436
Practice Address - Country:US
Practice Address - Phone:601-527-4796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health