MEDICARE: TAMPA BAY THERAPY AND TRAINING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1578216982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY THERAPY AND TRAINING SERVICES, LLC

Provider Business Mailing Address
First Line	:	15100 HUTCHISON RD STE 112
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-5512
Country	:	US
Telephone Number	:	813-438-3494
Fax Number	:

Provider Business Practice Location Address
First Line	:	15100 HUTCHISON RD STE 112
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-5512
Country	:	US
Telephone Number	:	813-438-3494
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IVYIA ADAMS
Credential	:	LMHC
Telephone Number	:	813-417-8238

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	01/27/2022

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