Organization
FLORIDA PSYCHOTHERAPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOMON JOHN THEKKETHOTTIYIL (MANAGER)
(727) 424-8423
Entity
Organization
Contact information
Practice address
106 W WINDHORST RD, BRANDON, FL 33510-2455
(813) 373-9531
Mailing address
3835 MISTY LANDING DR, VALRICO, FL 33594-4802
(727) 424-8423
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW10806
FL
Other
Enumeration date
06/18/2016
Last updated
06/18/2016
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