Provider Demographics
NPI:1386341451
Name:PSYCH SELF-EMPOWERMENT, LLC
Entity type:Organization
Organization Name:PSYCH SELF-EMPOWERMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:CHANTAL
Authorized Official - Last Name:JOASSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:877-506-5719
Mailing Address - Street 1:1626 W ORANGE BLOSSOM TRAIL
Mailing Address - Street 2:# 1099
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2641
Mailing Address - Country:US
Mailing Address - Phone:877-506-5719
Mailing Address - Fax:877-404-4738
Practice Address - Street 1:1098 LAKESIDE ESTATES DRIVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703
Practice Address - Country:US
Practice Address - Phone:877-506-5719
Practice Address - Fax:877-404-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health