Healthcare Provider Details

I. General information

NPI: 1750619862
Provider Name (Legal Business Name): INTELLEX ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9908 W LINEBAUGH AVE
TAMPA FL
33626-1858
US

IV. Provider business mailing address

3802 EHRLICH RD SUITE NUMBER 204
TAMPA FL
33624-2378
US

V. Phone/Fax

Practice location:
  • Phone: 813-926-4009
  • Fax:
Mailing address:
  • Phone: 813-968-4497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. JUDY A JOHNSON
Title or Position: OWNER
Credential: PHD, MA, MED
Phone: 813-987-9760