Provider Demographics
NPI:1447302633
Name:BAYTREE BEHAVIORAL HEALTH PA
Entity type:Organization
Organization Name:BAYTREE BEHAVIORAL HEALTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:L.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FAIRCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:321-253-8887
Mailing Address - Street 1:1370 BEDFORD DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1993
Mailing Address - Country:US
Mailing Address - Phone:321-253-8887
Mailing Address - Fax:321-253-8878
Practice Address - Street 1:1370 BEDFORD DR
Practice Address - Street 2:SUITE 106
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1993
Practice Address - Country:US
Practice Address - Phone:321-253-8887
Practice Address - Fax:321-253-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6051103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty