Healthcare Provider Details

I. General information

NPI: 1114525490
Provider Name (Legal Business Name): STINO THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E BLOOMINGDALE AVE
BRANDON FL
33511-8101
US

IV. Provider business mailing address

160 E BLOOMINGDALE AVE
BRANDON FL
33511-8101
US

V. Phone/Fax

Practice location:
  • Phone: 813-693-1332
  • Fax: 801-881-4579
Mailing address:
  • Phone: 813-602-5910
  • Fax: 801-881-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAYLA WATSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 813-602-5910