| Prosperity Behavioral Healthcare, Pllc | |
|
11912 Hayes Station Way Manassas VA 20109-4845 | |
| (323) 420-8787 | |
| (443) 331-4441 |
| Full Name | Prosperity Behavioral Healthcare, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 11912 Hayes Station Way, Manassas, Virginia |
| Authorized Official Name and Position | Stacy Tylor (OWNER) |
| Authorized Official Contact | 3234208787 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prosperity Behavioral Healthcare, Pllc 11912 Hayes Station Way Manassas VA 20109-4845 Ph: (323) 420-8787 | Prosperity Behavioral Healthcare, Pllc 11912 Hayes Station Way Manassas VA 20109-4845 Ph: (323) 420-8787 |
| NPI Number | 1679234744 |
|---|---|
| Provider Enumeration Date | 12/31/2021 |
| Last Update Date | 12/31/2021 |
| Certification Date | 12/31/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679234744 | NPI | - | NPPES |
| 1992015887 | Other | MD | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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