Organization
COLLABORATIVE PSYCH & MED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY WOOD BSW (ADMINISTRATOR)
(855) 732-5292
Entity
Organization
Contact information
Practice address
4406 S FLORIDA AVE STE 31, LAKELAND, FL 33813-2176
(855) 732-5292
(863) 583-9926
Mailing address
4406 S FLORIDA AVE STE 31, LAKELAND, FL 33813-2176
(855) 732-5292
(863) 583-9926
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
2084P0805X
Geriatric Psychiatry Physician
Primary
—
—
Other
Enumeration date
09/26/2018
Last updated
09/26/2018
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