Organization
PSYCHOLOGY CENTER FOR WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J PORTER PHD (PRESIDENT)
(813) 810-8110
Entity
Organization
Contact information
Practice address
308 E OAK AVE, TAMPA, FL 33602-2344
(813) 810-8110
(813) 225-5678
Mailing address
308 E OAK AVE, TAMPA, FL 33602-2344
(813) 810-8110
(813) 225-5678
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY6542
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54803
BSFL
FL
Enumeration date
08/15/2008
Last updated
08/15/2008
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