Healthcare Provider Details

I. General information

NPI: 1114295680
Provider Name (Legal Business Name): BAYCARE BEHAVIORAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 JACKSON ST N STE 302
ST PETERSBURG FL
33705-1449
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-820-7701
  • Fax:
Mailing address:
  • Phone: 727-281-9390
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNDA GORKEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 727-281-9390