Provider Demographics
NPI:1285968412
Name:PSYCHOTHERAPY SERVICES, INC
Entity type:Organization
Organization Name:PSYCHOTHERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KAUFMAN
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DS, MA, LMHC
Authorized Official - Phone:904-827-1777
Mailing Address - Street 1:269 S MATANZAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-4541
Mailing Address - Country:US
Mailing Address - Phone:904-827-1777
Mailing Address - Fax:904-827-1222
Practice Address - Street 1:4475 US 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7284
Practice Address - Country:US
Practice Address - Phone:904-827-1777
Practice Address - Fax:904-827-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty