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NPI Code Detail

MEDICARE: TAMPA BAY ACADEMY

MEDICARE: TAMPA BAY ACADEMY
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
1251S00000XCommunity/Behavioral Health AgencyMH9004FL

General Provider Information

NPI Number : 1811154933
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAMPA BAY ACADEMY
Provider Business Mailing Address
First Line : 12012 BOYETTE RD
Second Line :
City : RIVERVIEW
State : FL
Zip : 33569-5631
Country : US
Telephone Number : 813-677-6700
Fax Number : 813-671-3145
Provider Business Practice Location Address
First Line : 12012 BOYETTE RD
Second Line :
City : RIVERVIEW
State : FL
Zip : 33569-5631
Country : US
Telephone Number : 813-677-6700
Fax Number : 813-671-3145
Authorized Official
Title or Position : THERAPIST
Name : MRS. BOBBY JEAN COOPER
Credential : LMHC
Telephone Number : 813-677-6700
Provider Enumeration Date : 05/16/2008
Last Update Date : 05/16/2008

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Directions to “TAMPA BAY ACADEMY ” Practice Location

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