Organization
PROSPERITY BEHAVIORAL HEALTHCARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY TYLOR PSYD (OWNER)
(323) 420-8787
Entity
Organization
Contact information
Practice address
11912 HAYES STATION WAY, MANASSAS, VA 20109-4845
(323) 420-8787
(443) 331-4441
Mailing address
11912 HAYES STATION WAY, MANASSAS, VA 20109-4845
(323) 420-8787
(443) 331-4441
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992015887
NPI
MD
Enumeration date
12/31/2021
Last updated
12/31/2021
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