Healthcare Provider Details

I. General information

NPI: 1861014078
Provider Name (Legal Business Name): ALLIANCE MENTAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13575 58TH ST N STE 115
CLEARWATER FL
33760-3755
US

IV. Provider business mailing address

1468 62ND AVE S
ST PETERSBURG FL
33705-5623
US

V. Phone/Fax

Practice location:
  • Phone: 727-741-7345
  • Fax:
Mailing address:
  • Phone: 727-741-7345
  • Fax: 727-290-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JAMES MOSES
Title or Position: CEO
Credential: LCSW
Phone: 727-741-7345