Healthcare Provider Details

I. General information

NPI: 1982958633
Provider Name (Legal Business Name): BE-COS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 NORTH FLORIDA AVE
TAMPA FL
33602-2615
US

IV. Provider business mailing address

6319 CHAUNCY STREET
TAMPA FL
33647-1106
US

V. Phone/Fax

Practice location:
  • Phone: 813-631-5176
  • Fax: 813-631-1119
Mailing address:
  • Phone: 813-631-5176
  • Fax: 813-631-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY2445
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPY2445
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY2445
License Number StateFL

VIII. Authorized Official

Name: DR. JAMES JOHN MESSINA
Title or Position: CLINICAL DIRECTOR, BE-COS COUNSELIN
Credential: PH.D.
Phone: 813-631-5176