Healthcare Provider Details

I. General information

NPI: 1922411263
Provider Name (Legal Business Name): GPSPNP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 SHADEHILL CT
TAMPA FL
33612-5044
US

IV. Provider business mailing address

2216 SHADEHILL CT
TAMPA FL
33612-5044
US

V. Phone/Fax

Practice location:
  • Phone: 813-495-4773
  • Fax: 813-935-4771
Mailing address:
  • Phone: 813-495-4773
  • Fax: 813-935-4771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN P MCDONOUGH III
Title or Position: MANAGER/OWNER
Credential: PH.D.
Phone: 813-495-4773