MEDICARE: NORTH STAR BEHAVIORAL HEALTH 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1962962704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH STAR BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	850 E LIME ST # 2027
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-4702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 E LIME ST # 2027
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-4702
Country	:	US
Telephone Number	:	727-218-9383
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD EAKES JR.
Credential	:	LCSW
Telephone Number	:	727-218-9383

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	03/20/2019

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