Provider Demographics
NPI:1316520109
Name:OPTIMIZED PSYCHOLOGICAL CONSULTING LLC
Entity type:Organization
Organization Name:OPTIMIZED PSYCHOLOGICAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:239-287-1044
Mailing Address - Street 1:6425 NW 27TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-7102
Mailing Address - Country:US
Mailing Address - Phone:239-297-1044
Mailing Address - Fax:
Practice Address - Street 1:6425 NW 27TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-7102
Practice Address - Country:US
Practice Address - Phone:239-297-1044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)