Provider Demographics
NPI:1528732385
Name:TYKES & TEENS, INC.
Entity type:Organization
Organization Name:TYKES & TEENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZAYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-220-3439
Mailing Address - Street 1:900 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2471
Mailing Address - Country:US
Mailing Address - Phone:772-220-3439
Mailing Address - Fax:772-220-3484
Practice Address - Street 1:451 SW BETHANY DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1964
Practice Address - Country:US
Practice Address - Phone:772-220-3439
Practice Address - Fax:772-220-3484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TYKES & TEENS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-05
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103326000Medicaid