Healthcare Provider Details

I. General information

NPI: 1013902956
Provider Name (Legal Business Name): THE CRISIS CENTER OF TAMPA BAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CRISIS CENTER PLAZA
TAMPA FL
33613-1238
US

IV. Provider business mailing address

ONE CRISIS CENTER PLAZA
TAMPA FL
33613-1238
US

V. Phone/Fax

Practice location:
  • Phone: 813-964-1964
  • Fax: 813-969-4950
Mailing address:
  • Phone: 813-964-1964
  • Fax: 813-969-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number85-8012527472C-9
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number85-8012527472C-9
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number85-8012527472C9
License Number State

VIII. Authorized Official

Name: CLARA ALLYSON REYNOLDS
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 813-964-1964