Healthcare Provider Details

I. General information

NPI: 1245502152
Provider Name (Legal Business Name): BAYCARE BEHAVIORAL HEALTH ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21808 STATE ROAD 54
LUTZ FL
33549-6923
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-315-6974
  • Fax: 813-635-2613
Mailing address:
  • Phone: 727-315-6974
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. LYNDA GORKEN
Title or Position: VP
Credential:
Phone: 727-281-9202