Provider Demographics
NPI:1932579133
Name:PSYCH CONSULTANTS GROUP LLC
Entity type:Organization
Organization Name:PSYCH CONSULTANTS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:754-246-5618
Mailing Address - Street 1:2731 EXECUTIVE PARK DR STE 9
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3659
Mailing Address - Country:US
Mailing Address - Phone:754-246-5618
Mailing Address - Fax:954-616-8101
Practice Address - Street 1:2731 EXECUTIVE PARK DR STE 9
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3659
Practice Address - Country:US
Practice Address - Phone:754-246-5618
Practice Address - Fax:954-616-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105576000Medicaid