Healthcare Provider Details

I. General information

NPI: 1871271791
Provider Name (Legal Business Name): THE THERAPY CENTER OF BRANDON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6338 US HIGHWAY 301 S
RIVERVIEW FL
33578-3829
US

IV. Provider business mailing address

6338 US HIGHWAY 301 S
RIVERVIEW FL
33578-3829
US

V. Phone/Fax

Practice location:
  • Phone: 813-245-2148
  • Fax:
Mailing address:
  • Phone: 813-245-2148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: RONDA E PORTER
Title or Position: DIRECTOR
Credential: PH. D., LMFT
Phone: 813-245-2148