Healthcare Provider Details

I. General information

NPI: 1679581250
Provider Name (Legal Business Name): CAMELOT COMMUNITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15500 ROOSEVELT BLVD STE 204
CLEARWATER FL
33760-3430
US

IV. Provider business mailing address

15500 ROOSEVELT BLVD STE 204
CLEARWATER FL
33760-3430
US

V. Phone/Fax

Practice location:
  • Phone: 727-593-0003
  • Fax: 727-595-0735
Mailing address:
  • Phone: 727-593-0003
  • Fax: 727-595-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL
# 7
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANA ALLEN
Title or Position: DIRECTOR OF AR
Credential:
Phone: 727-593-0003